Provider Demographics
NPI:1598200438
Name:BAXTER, SEAN MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MICHAEL
Last Name:BAXTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 N US HIGHWAY 17 92
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3167
Mailing Address - Country:US
Mailing Address - Phone:707-726-2768
Mailing Address - Fax:
Practice Address - Street 1:5805 MAIN BAYVIEW RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4831
Practice Address - Country:US
Practice Address - Phone:707-726-2768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020436-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant