Provider Demographics
NPI:1679354914
Name:ZIPAY, SEAN THOMAS
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:ZIPAY
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 1:53652 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-5849
Mailing Address - Country:US
Mailing Address - Phone:586-405-0067
Mailing Address - Fax:
Practice Address - Street 1:53652 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5849
Practice Address - Country:US
Practice Address - Phone:586-405-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner