Provider Demographics
NPI:1154078558
Name:ABRAHAM, SEAN M (CRNA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E MARSHALL ST APT 128
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6350
Mailing Address - Country:US
Mailing Address - Phone:240-672-4532
Mailing Address - Fax:
Practice Address - Street 1:1700 E MARSHALL ST APT 128
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6350
Practice Address - Country:US
Practice Address - Phone:240-672-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216305163W00000X
NY876592367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse