MEDICARE: DR. SEAN SOORENA ZADEH 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	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	96285	SC

General Provider Information

NPI Number	:	1649774563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN SOORENA ZADEH MD

Provider Business Mailing Address
First Line	:	2 INNOVATION DR STE 350
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5269
Country	:	US
Telephone Number	:	864-516-1170
Fax Number	:	877-249-9483

Provider Business Practice Location Address
First Line	:	2 INNOVATION DR STE 350
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5269
Country	:	US
Telephone Number	:	864-516-1170
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	06/11/2026

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