Healthcare Provider Details

I. General information

NPI: 1427254473
Provider Name (Legal Business Name): SEAN DAVID WILEY R.T.(R)(VI),RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4320 NW 4TH CIR
OCALA FL
34475-9519
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0116
  • Fax: 352-265-0067
Mailing address:
  • Phone: 352-266-2114
  • Fax: 352-265-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number307118
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number03FL1057
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: