Provider Demographics
NPI:1689373193
Name:MCKENNA, SEAN KODY
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:KODY
Last Name:MCKENNA
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:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-0461
Mailing Address - Country:US
Mailing Address - Phone:970-227-2800
Mailing Address - Fax:
Practice Address - Street 1:1977 SHADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3519
Practice Address - Country:US
Practice Address - Phone:970-227-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications