Provider Demographics
NPI:1255866844
Name:NELLER, SEAN BENJAMIN (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:BENJAMIN
Last Name:NELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N O'CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7530
Mailing Address - Country:US
Mailing Address - Phone:972-259-3541
Mailing Address - Fax:972-225-4101
Practice Address - Street 1:620 N O'CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7530
Practice Address - Country:US
Practice Address - Phone:972-259-3541
Practice Address - Fax:972-225-4101
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine