Healthcare Provider Details

I. General information

NPI: 1366829004
Provider Name (Legal Business Name): SEAN PATRICK FERRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC-B
APO AE
09114-0057
US

IV. Provider business mailing address

30 N 1900 E RM 1C412
SALT LAKE CITY UT
84132-3277
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3004
  • Fax:
Mailing address:
  • Phone: 801-581-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10100332-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: