MEDICARE: SEAN A MADDOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1104433994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN A MADDOX

Provider Business Mailing Address
First Line	:	6015 N AMERICAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1807
Country	:	US
Telephone Number	:	267-312-5654
Fax Number	:

Provider Business Practice Location Address
First Line	:	6015 N AMERICAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1807
Country	:	US
Telephone Number	:	267-312-5654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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Directions to “ SEAN A MADDOX ” Practice Location

Language	Start Address	Practice Location

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