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General NPI Number Information
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NPI Number | 1528702776
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Entity Type | Individual
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Provider Name | SEAN WHELEN
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Gender | Male
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 07/22/2023
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Provider Practice Location Address
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Address Line | 2212 PENFIELD RD STE 200
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City | PENFIELD
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State | NY
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Zip | 14526-1756
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Country | US
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Telephone | 585-598-8565
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HOMESTEAD DR
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City | FAIRPORT
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State | NY
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Zip | 14450-1519
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Country | US
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Telephone | 585-406-1998
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 310711
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 310711
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License Number State | NY
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