Provider Demographics
NPI:1114357456
Name:KIBRIA, SEAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:KIBRIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 GOLDEN GATE PARKWAY
Mailing Address - Street 2:STE 4
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7529
Mailing Address - Country:US
Mailing Address - Phone:239-238-8925
Mailing Address - Fax:239-353-7001
Practice Address - Street 1:5475 GOLDEN GATE PARKWAY
Practice Address - Street 2:STE 4
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7529
Practice Address - Country:US
Practice Address - Phone:239-238-8925
Practice Address - Fax:239-353-7001
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3769213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery