Provider Demographics
NPI:1427413434
Name:WHITLOW, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WHITLOW
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 1:3902 HENDERSON BLVD
Mailing Address - Street 2:SUITE 208-215
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5038
Mailing Address - Country:US
Mailing Address - Phone:813-866-8440
Mailing Address - Fax:
Practice Address - Street 1:3902 HENDERSON BLVD
Practice Address - Street 2:SUITE 208-215
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5038
Practice Address - Country:US
Practice Address - Phone:813-866-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079856990Medicaid