Provider Demographics
NPI:1063484848
Name:TIRNEY, SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:TIRNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:PETER
Other - Last Name:TIRNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1925 S ATLANTIC AVE
Mailing Address - Street 2:SUITE #609
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5026
Mailing Address - Country:US
Mailing Address - Phone:386-747-4240
Mailing Address - Fax:
Practice Address - Street 1:1925 S ATLANTIC AVE
Practice Address - Street 2:SUITE #609
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-5026
Practice Address - Country:US
Practice Address - Phone:386-747-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83528208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262724800Medicaid
FL0471260001Medicare NSC
H15355Medicare UPIN
FL262724800Medicaid