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General NPI Number Information
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NPI Number | 1558910752
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Entity Type | Individual
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Provider Name | SEAN M. ROBERTS
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1300 ELMWOOD AVE # 108
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City | BUFFALO
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State | NY
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Zip | 14222-1004
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Country | US
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Telephone | 716-878-5328
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Fax | 716-878-3536
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Provider Business Mailing Address
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Address Line | 9 BIGELOW RD
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-1507
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Country | US
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Telephone | 716-989-8119
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000671
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License Number State | NY
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