Healthcare Provider Details

I. General information

NPI: 1033852587
Provider Name (Legal Business Name): SEAN GOLDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

17714 LOMOND CT
BOCA RATON FL
33496-1032
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-5365
  • Fax:
Mailing address:
  • Phone: 561-400-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: