Healthcare Provider Details

I. General information

NPI: 1851128466
Provider Name (Legal Business Name): SEAN DANIEL VIGNOLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 UNIVERSITY BLVD
WINTER PARK FL
32792-6713
US

IV. Provider business mailing address

11939 BOARDWALK DR
ORLANDO FL
32826-2962
US

V. Phone/Fax

Practice location:
  • Phone: 954-647-6805
  • Fax:
Mailing address:
  • Phone: 954-647-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: