Provider Demographics
NPI:1891599106
Name:TALLEY, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:TALLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 SABLE BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6999
Mailing Address - Country:US
Mailing Address - Phone:901-672-4118
Mailing Address - Fax:
Practice Address - Street 1:1177 SABLE BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6999
Practice Address - Country:US
Practice Address - Phone:901-672-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications