Provider Demographics
NPI:1578582128
Name:MURPHY, SEAN M (NP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:MURPHY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-2204
Mailing Address - Country:US
Mailing Address - Phone:315-243-7767
Mailing Address - Fax:315-214-8650
Practice Address - Street 1:144 CENTURY DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-2204
Practice Address - Country:US
Practice Address - Phone:315-243-7767
Practice Address - Fax:315-214-8650
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334169363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02807830Medicaid
NYJ400000511Medicare PIN
NY02807830Medicaid