Healthcare Provider Details

I. General information

NPI: 1568538783
Provider Name (Legal Business Name): SEAN A SUKAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 NORTH MILITARY TRAIL SUITE 100
BOCA RATON FL
33431
US

IV. Provider business mailing address

2900 NORTH MILITARY TRAIL SUITE 100
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 561-245-8877
  • Fax: 561-322-3920
Mailing address:
  • Phone: 561-245-8877
  • Fax: 561-322-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME98259
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME98259
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number229964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: