Provider Demographics
NPI:1538125760
Name:MACHANDA, SEAN DEV (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:DEV
Last Name:MACHANDA
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 1:4510 DORR ST # MS 840
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4040
Mailing Address - Country:US
Mailing Address - Phone:419-479-2665
Mailing Address - Fax:419-479-2639
Practice Address - Street 1:1000 REGENCY CT STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3074
Practice Address - Country:US
Practice Address - Phone:419-479-2665
Practice Address - Fax:419-479-2639
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541511Medicaid
OH000000355505OtherBLUE CROSS BLUE SHIELD
OH341300581050OtherCARESOURCE
OH7631642OtherAETNA
OH741102OtherBUCKEYE
OH2541511Medicaid
OH386450OtherWELLCARE
OHF84299OtherAPEX
I31243Medicare UPIN
OHH020490Medicare PIN
OH4160152Medicare PIN
OH386450OtherWELLCARE