Provider Demographics
NPI:1619264918
Name:HAMMOND, SEAN L
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:L
Last Name:HAMMOND
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 1:4615 PHILLIPS HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7265
Mailing Address - Country:US
Mailing Address - Phone:904-730-8265
Mailing Address - Fax:904-737-3412
Practice Address - Street 1:4615 PHILLIPS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7265
Practice Address - Country:US
Practice Address - Phone:904-730-8265
Practice Address - Fax:904-737-3412
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003539100251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003539100Medicaid