Healthcare Provider Details

I. General information

NPI: 1861324071
Provider Name (Legal Business Name): SEAN R BURGESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 DUDLEY BLVD
MCCLELLAN CA
95652-1024
US

IV. Provider business mailing address

7485 CANDLEWOOD WAY
SACRAMENTO CA
95822-5149
US

V. Phone/Fax

Practice location:
  • Phone: 916-420-7807
  • Fax:
Mailing address:
  • Phone: 916-420-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: