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General NPI Number Information
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NPI Number | 1174587745
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Entity Type | Individual
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Provider Name | SEAN P SCULLY MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 2145 COUNTRY CLUB RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-2400
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Country | US
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Telephone | 910-939-5759
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Fax | 910-939-4951
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Provider Business Mailing Address
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Address Line | 3714 GUARDIAN AVE SUITE E
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City | MOREHEAD CITY
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State | NC
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Zip | 28557-2974
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Country | US
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Telephone | 252-247-2101
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Fax | 252-247-9469
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 9300310
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License Number State | NC
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