Provider Demographics
NPI:1265769962
Name:LOVALLO, SEAN JOSEPH (PA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:JOSEPH
Last Name:LOVALLO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2337
Mailing Address - Country:US
Mailing Address - Phone:850-494-0000
Mailing Address - Fax:850-494-0001
Practice Address - Street 1:4624 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2337
Practice Address - Country:US
Practice Address - Phone:850-494-0000
Practice Address - Fax:850-494-0001
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015389363A00000X
NJ25MP00228500363A00000X
FLPA9113427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03497445Medicaid
NY03497445Medicaid