Provider Demographics
NPI:1063063873
Name:EUSANTOS, SEAN SCOTT
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:SCOTT
Last Name:EUSANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 28TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3505
Mailing Address - Country:US
Mailing Address - Phone:206-491-6004
Mailing Address - Fax:
Practice Address - Street 1:14001 28TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3505
Practice Address - Country:US
Practice Address - Phone:206-491-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide