Healthcare Provider Details

I. General information

NPI: 1629777941
Provider Name (Legal Business Name): MR. SEAN ROBERT STUMBO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E WHITTIER ST
COLUMBUS OH
43206-2977
US

IV. Provider business mailing address

825 E WHITTIER ST
COLUMBUS OH
43206-2977
US

V. Phone/Fax

Practice location:
  • Phone: 614-965-7531
  • Fax: 614-991-5892
Mailing address:
  • Phone: 614-965-7531
  • Fax: 614-991-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: