Healthcare Provider Details

I. General information

NPI: 1720612955
Provider Name (Legal Business Name): SEAN OENICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 06/21/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 POCAHONTAS ST STE 100
NORFOLK VA
23511-2133
US

IV. Provider business mailing address

1084 POCAHONTAS ST STE 100
NORFOLK VA
23511-2133
US

V. Phone/Fax

Practice location:
  • Phone: 585-286-7934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102206863
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102206863
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: