Provider Demographics
NPI:1215499975
Name:LLEWELLYN, SEAN ROGERS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ROGERS
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6087
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:2721 BRONXWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3642
Practice Address - Country:US
Practice Address - Phone:718-765-6350
Practice Address - Fax:347-736-0207
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0065851207Q00000X
IL036.161591207Q00000X
390200000X
NY332392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program