Healthcare Provider Details

I. General information

NPI: 1700768744
Provider Name (Legal Business Name): SEAN FAUGHNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

60 COLUMBIA ST FL 4
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 702-808-4800
  • Fax:
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-843-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9120804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: