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General NPI Number Information
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NPI Number | 1316902489
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Entity Type | Individual
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Provider Name | SEAN KEVIN PIECHOCKI PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 55 FRUIT ST
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City | BOSTON
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State | MA
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Zip | 02114-2621
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Country | US
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Telephone | 401-741-1884
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 415348
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City | BOSTON
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State | MA
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Zip | 02241-5348
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT00163
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00486
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 013021
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3777
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License Number State | MA
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