Provider Demographics
NPI:1417695495
Name:KACEROSKY, SEAN THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:KACEROSKY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6750 TRYON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7056
Mailing Address - Country:US
Mailing Address - Phone:919-378-2332
Mailing Address - Fax:919-378-2333
Practice Address - Street 1:6750 TRYON RD STE 103
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7056
Practice Address - Country:US
Practice Address - Phone:919-378-2332
Practice Address - Fax:919-378-2333
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-14579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant