Provider Demographics
NPI:1427254473
Name:WILEY, SEAN DAVID (RT(R)(VI),RPA)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:DAVID
Last Name:WILEY
Suffix:
Gender:M
Credentials:RT(R)(VI),RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 NW 4TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-9519
Mailing Address - Country:US
Mailing Address - Phone:352-266-2114
Mailing Address - Fax:352-265-0067
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0116
Practice Address - Fax:352-265-0067
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3071182471V0106X
03FL1057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCRT44438OtherFLORIDA RT LICENSE
307118OtherARRT
03FL1057OtherCBRPA LICENSE