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General NPI Number Information
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NPI Number | 1255866844
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Entity Type | Individual
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Provider Name | SEAN BENJAMIN NELLER DO
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Gender | Male
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 620 N O'CONNOR RD
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City | IRVING
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State | TX
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Zip | 75061-7530
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Country | US
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Telephone | 972-259-3541
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Fax | 972-225-4101
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Provider Business Mailing Address
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Address Line | 620 N O'CONNOR RD
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City | IRVING
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State | TX
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Zip | 75061-7530
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Country | US
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Telephone | 972-259-3541
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Fax | 972-225-4101
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | S2855
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License Number State | TX
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