Provider Demographics
NPI:1164651709
Name:MULCAHY, SEAN C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:C
Last Name:MULCAHY
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 1:3245 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7439
Mailing Address - Country:US
Mailing Address - Phone:800-237-6723
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:200 SE HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2346
Practice Address - Country:US
Practice Address - Phone:800-237-6723
Practice Address - Fax:866-665-2702
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001030709367500000X
FL9289925367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered