MEDICARE: SEAN C MABEY MD

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	2083P0901X	Public Health & General Preventive Medicine Physician	2018-02367	NC

General Provider Information

NPI Number	:	1114380359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN C MABEY MD

Provider Business Mailing Address
First Line	:	2608 NESTLEBROOK TRL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-8201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 NESTLEBROOK TRL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-8201
Country	:	US
Telephone Number	:	414-795-3692
Fax Number	:

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

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	11/26/2018

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