MEDICARE: SEAN PAUL PERONTO PA

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1932832532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN PAUL PERONTO PA

Provider Business Mailing Address
First Line	:	5262 BISHOPS BAY PKWY UNIT 216
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53597-8829
Country	:	US
Telephone Number	:	920-242-5223
Fax Number	:

Provider Business Practice Location Address
First Line	:	5262 BISHOPS BAY PKWY UNIT 216
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53597-8829
Country	:	US
Telephone Number	:	920-242-5223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	06/14/2024

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Directions to “ SEAN PAUL PERONTO PA” Practice Location

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