Provider Demographics
NPI:1598012023
Name:CHILLEMI, SEAN EAMON (LA,C, LMT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:EAMON
Last Name:CHILLEMI
Suffix:
Gender:M
Credentials:LA,C, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3206
Mailing Address - Country:US
Mailing Address - Phone:914-484-7720
Mailing Address - Fax:
Practice Address - Street 1:42 N BROADWAY
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3206
Practice Address - Country:US
Practice Address - Phone:914-484-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist