Provider Demographics
NPI:1487642617
Name:SHANAHAN, SEAN DIEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:DIEN
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16621 LAGOON SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5200
Mailing Address - Country:US
Mailing Address - Phone:813-653-6100
Mailing Address - Fax:855-711-0314
Practice Address - Street 1:16621 LAGOON SHORE BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5200
Practice Address - Country:US
Practice Address - Phone:813-653-6100
Practice Address - Fax:855-711-0314
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3134213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9762Medicare PIN
5756010001Medicare NSC
FLV00135Medicare UPIN