Healthcare Provider Details

I. General information

NPI: 1083277446
Provider Name (Legal Business Name): SEAN TANSEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11551 NUCKOLS RD STE C
GLEN ALLEN VA
23059-5565
US

IV. Provider business mailing address

11551 NUCKOLS RD STE C
GLEN ALLEN VA
23059-5565
US

V. Phone/Fax

Practice location:
  • Phone: 804-888-6800
  • Fax: 804-888-6800
Mailing address:
  • Phone: 804-888-6800
  • Fax: 804-888-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113283
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110007589
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA202814
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: