Healthcare Provider Details

I. General information

NPI: 1346767993
Provider Name (Legal Business Name): MR. SEAN QUINN DUNBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WEST MAIN STREET
DANVILLE VA
24541
US

IV. Provider business mailing address

420 W MAIN ST
DANVILLE VA
24541-3612
US

V. Phone/Fax

Practice location:
  • Phone: 919-264-6453
  • Fax:
Mailing address:
  • Phone: 919-264-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: