Provider Demographics
NPI:1467643221
Name:MARTIN, SEAN NICHOLAS (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:NICHOLAS
Last Name:MARTIN
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 1:17425 7TH ST STE 560174
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3206
Mailing Address - Country:US
Mailing Address - Phone:407-544-0166
Mailing Address - Fax:
Practice Address - Street 1:17425 7TH ST STE 560174
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-3206
Practice Address - Country:US
Practice Address - Phone:407-544-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10526207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine