Healthcare Provider Details

I. General information

NPI: 1508229493
Provider Name (Legal Business Name): SEAN STEPHEN MCCARTHY BULLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

D13 STONEHEDGE DR
SOUTH BURLINGTON VT
05403-7365
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-7911
  • Fax:
Mailing address:
  • Phone: 802-363-8015
  • Fax:

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042-0014530
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number324710
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042-0014530
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: