Provider Demographics
NPI:1497237085
Name:EDDY, SEAN AUSTIN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:AUSTIN
Last Name:EDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E BINNER DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1498
Mailing Address - Country:US
Mailing Address - Phone:480-275-1931
Mailing Address - Fax:
Practice Address - Street 1:1211 E BINNER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1498
Practice Address - Country:US
Practice Address - Phone:480-275-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant