Healthcare Provider Details

I. General information

NPI: 1881320646
Provider Name (Legal Business Name): CULLEN SEAN SWEENEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 S SAINT FRANCIS DR STE 202
SANTA FE NM
87505-4202
US

IV. Provider business mailing address

1475 RODEO RD APT 151
SANTA FE NM
87505-6853
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-1110
  • Fax:
Mailing address:
  • Phone: 312-593-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD0981
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: