Provider Demographics
NPI:1194352054
Name:MCDERMOTT, SEAN MICHAEL
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:MCDERMOTT
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 1:3707 KINGS MILL RUN
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3961
Mailing Address - Country:US
Mailing Address - Phone:440-525-4523
Mailing Address - Fax:
Practice Address - Street 1:3707 KINGS MILL RUN
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3961
Practice Address - Country:US
Practice Address - Phone:440-525-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program