Healthcare Provider Details

I. General information

NPI: 1255824678
Provider Name (Legal Business Name): SEAN GARLAND MSACN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 GRANDE CORNICHE
PALM BEACH GARDENS FL
33410-1613
US

IV. Provider business mailing address

616 CLEARWATER PARK RD APT 1201
WEST PALM BEACH FL
33401-6250
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-0333
  • Fax:
Mailing address:
  • Phone: 315-243-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: