Healthcare Provider Details

I. General information

NPI: 1114357456
Provider Name (Legal Business Name): SEAN M. KIBRIA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 GOLDEN GATE PARKWAY STE 4
NAPLES FL
34116-7529
US

IV. Provider business mailing address

5475 GOLDEN GATE PARKWAY STE 4
NAPLES FL
34116-7529
US

V. Phone/Fax

Practice location:
  • Phone: 239-238-8925
  • Fax: 239-353-7001
Mailing address:
  • Phone: 239-238-8925
  • Fax: 239-353-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: