Provider Demographics
NPI:1275093254
Name:UDELL, SEAN MANNING (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MANNING
Last Name:UDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ROUND VALLEY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7549
Mailing Address - Country:US
Mailing Address - Phone:435-649-7680
Mailing Address - Fax:
Practice Address - Street 1:750 ROUND VALLEY DR STE 201
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7549
Practice Address - Country:US
Practice Address - Phone:435-649-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT218016207R00000X, 2084P0800X
PAMD4745562084P0800X
UT13141285-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine