Provider Demographics
NPI:1336021609
Name:DEELEY, SEAN DOUGLAS
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:DOUGLAS
Last Name:DEELEY
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 1:179 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2659
Mailing Address - Country:US
Mailing Address - Phone:814-952-3170
Mailing Address - Fax:
Practice Address - Street 1:2141 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3435
Practice Address - Country:US
Practice Address - Phone:440-443-0442
Practice Address - Fax:440-755-8010
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant