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General NPI Number Information
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NPI Number | 1205976487
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Entity Type | Individual
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Provider Name | SEAN PATRICK ALONZA BANNISTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 745 NW FEDERAL HWY
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City | STUART
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State | FL
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Zip | 34994-1016
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Country | US
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Telephone | 772-247-7545
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Fax | 772-264-3272
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Provider Business Mailing Address
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Address Line | 745 NW FEDERAL HWY
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City | STUART
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State | FL
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Zip | 34994-1016
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Country | US
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Telephone | 772-247-7545
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Fax | 772-264-3272
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9105846
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9105846
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License Number State | FL
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