Provider Demographics
NPI:1245405158
Name:HAILEY, SEAN PATRICK (NP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:HAILEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 MILITARY ROAD
Mailing Address - Street 2:SUITE 10 A & 10 B
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1983
Mailing Address - Country:US
Mailing Address - Phone:716-298-0080
Mailing Address - Fax:
Practice Address - Street 1:5290 MILITARY ROAD SUITE 10 A & B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1953
Practice Address - Country:US
Practice Address - Phone:716-298-0080
Practice Address - Fax:716-298-0956
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner