Healthcare Provider Details

I. General information

NPI: 1932556909
Provider Name (Legal Business Name): SEAN COLE MSN, NP, ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RED CREEK DR STE 200
ROCHESTER NY
14623-4300
US

IV. Provider business mailing address

600 RED CREEK DR STE 200
ROCHESTER NY
14623-4300
US

V. Phone/Fax

Practice location:
  • Phone: 585-222-6566
  • Fax:
Mailing address:
  • Phone: 585-222-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number657098
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: