Provider Demographics
NPI:1487147682
Name:MAIOLO, SEAN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ANTHONY
Last Name:MAIOLO
Suffix:
Gender:M
Credentials:MD
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 4054
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-4054
Mailing Address - Country:US
Mailing Address - Phone:928-460-2920
Mailing Address - Fax:
Practice Address - Street 1:302 W WILLIS ST STE 107
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3032
Practice Address - Country:US
Practice Address - Phone:928-460-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine