Healthcare Provider Details

I. General information

NPI: 1285953588
Provider Name (Legal Business Name): MICHAEL PATRICK SWEENEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3690 BOX MDG
APO AE
09126-3690
US

IV. Provider business mailing address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

V. Phone/Fax

Practice location:
  • Phone: 314-452-3184
  • Fax:
Mailing address:
  • Phone: 850-881-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005387
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001003463
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: