Provider Demographics
NPI:1982818043
Name:MUNNELLY, SEAN W (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:W
Last Name:MUNNELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KEKAULIKE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2462
Mailing Address - Country:US
Mailing Address - Phone:808-974-4300
Mailing Address - Fax:
Practice Address - Street 1:37 KEKAULIKE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2462
Practice Address - Country:US
Practice Address - Phone:808-974-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012383102084N0400X
HIHI-148412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry