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General NPI Number Information
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NPI Number | 1245405158
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Entity Type | Individual
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Provider Name | SEAN PATRICK HAILEY NP
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Gender | Male
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 5290 MILITARY ROAD SUITE 10 A & B
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City | LEWISTON
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State | NY
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Zip | 14092-1953
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Country | US
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Telephone | 716-298-0080
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Fax | 716-298-0956
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Provider Business Mailing Address
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Address Line | 5290 MILITARY ROAD SUITE 10 A & 10 B
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City | LEWISTON
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State | NY
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Zip | 14092-1983
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Country | US
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Telephone | 716-298-0080
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 304619
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License Number State | NY
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