Healthcare Provider Details

I. General information

NPI: 1144055351
Provider Name (Legal Business Name): SEAN GOREY CNS, CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ALBANY TPKE STE 927
CANTON CT
06019-2552
US

IV. Provider business mailing address

39 AMHERST PL
STAMFORD CT
06902-8303
US

V. Phone/Fax

Practice location:
  • Phone: 860-507-7365
  • Fax:
Mailing address:
  • Phone: 203-461-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number002665
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: