Healthcare Provider Details

I. General information

NPI: 1134864556
Provider Name (Legal Business Name): SEAN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W THOMAS RD
PHOENIX AZ
85013-4407
US

IV. Provider business mailing address

240 W THOMAS RD
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 866-945-3953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR79446
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: