Provider Demographics
NPI:1205151511
Name:KASTETTER, SEAN (MA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KASTETTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NORTH 11TH STREET
Mailing Address - Street 2:NELSON CLINIC, 3RD FLOOR, ROOM 304
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0150
Mailing Address - Country:US
Mailing Address - Phone:804-828-0431
Mailing Address - Fax:
Practice Address - Street 1:403 N 11TH ST
Practice Address - Street 2:NELSON CLINIC, 3RD FLOOR, ROOM 304
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5046
Practice Address - Country:US
Practice Address - Phone:804-828-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000535231HA2400X
VA2101000859237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist