Provider Demographics
NPI:1821428673
Name:SIMS, SEAN ROBERT MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ROBERT MICHAEL
Last Name:SIMS
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:PO BOX 412047
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20311 LAPPANS RD STE 100
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2037
Practice Address - Country:US
Practice Address - Phone:301-432-8470
Practice Address - Fax:301-432-8470
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056472363A00000X
PAOA003146363A00000X
MDC06711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant