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General NPI Number Information
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NPI Number | 1215499975
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Entity Type | Individual
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Provider Name | SEAN ROGERS LLEWELLYN MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2721 BRONXWOOD AVE
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City | BRONX
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State | NY
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Zip | 10469-3642
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Country | US
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Telephone | 718-765-6350
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Fax | 347-736-0207
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Provider Business Mailing Address
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Address Line | PO BOX 746087
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City | ATLANTA
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State | GA
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Zip | 30374-6087
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Country | US
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Telephone | 312-733-9730
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0065851
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.161591
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 332392
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License Number State | NY
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