Healthcare Provider Details

I. General information

NPI: 1134706641
Provider Name (Legal Business Name): SEAN HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 CHANDLER ST
WORCESTER MA
01609-3088
US

IV. Provider business mailing address

199 CHANDLER ST
WORCESTER MA
01609-3088
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1015568
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: