Provider Demographics
NPI:1275775686
Name:LEONARD, SEAN MATTHEW (MACOM)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MATTHEW
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 ROBINHOOD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3620
Mailing Address - Country:US
Mailing Address - Phone:941-525-3752
Mailing Address - Fax:
Practice Address - Street 1:1918 ROBINHOOD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3620
Practice Address - Country:US
Practice Address - Phone:941-525-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2244171100000X
WA00002548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist