Healthcare Provider Details

I. General information

NPI: 1225422041
Provider Name (Legal Business Name): SEAN DESIMONE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL WAY SUITE 101
SOMERSET KY
42503-2872
US

IV. Provider business mailing address

350 HOSPITAL WAY SUITE 101
SOMERSET KY
42503-2872
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-5093
  • Fax: 606-451-5087
Mailing address:
  • Phone: 606-451-5093
  • Fax: 606-451-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04123
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: