Healthcare Provider Details

I. General information

NPI: 1700205952
Provider Name (Legal Business Name): SEAN KELLY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE STE 200
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

8100 THREE CHOPT RD RM 119
HENRICO VA
23229-4837
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2300
  • Fax: 804-418-3062
Mailing address:
  • Phone: 804-527-2800
  • Fax: 804-420-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0102207131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: