Healthcare Provider Details

I. General information

NPI: 1275279846
Provider Name (Legal Business Name): SEAN LLANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5798 S SEMORAN BLVD BLDG F
ORLANDO FL
32822-4819
US

IV. Provider business mailing address

1139 VIZCAYA LAKE RD APT 11-208
OCOEE FL
34761-6962
US

V. Phone/Fax

Practice location:
  • Phone: 855-819-4886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: