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NPI Code Detail

MEDICARE: DR. SEAN FENTON DO

MEDICARE:  DR. SEAN  FENTON  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician208830NY

General Provider Information

NPI Number : 1861505638
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SEAN FENTON DO
Provider Business Mailing Address
First Line : 9203 OUTLOOK ROCK TRL
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-9528
Country : US
Telephone Number : 917-517-7585
Fax Number : 419-793-8121
Provider Business Practice Location Address
First Line : 251 RICHMOND HILL RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5906
Country : US
Telephone Number : 917-517-7585
Fax Number : 419-793-8121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 01/25/2016

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Directions to “ DR. SEAN FENTON DO” Practice Location

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