Provider Demographics
NPI:1396798393
Name:NEUFELDT, SEAN HENRI (MSN, FNP)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:HENRI
Last Name:NEUFELDT
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7208
Mailing Address - Country:US
Mailing Address - Phone:469-626-8512
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:600 S MAIN ST STE 3.200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2410
Practice Address - Country:US
Practice Address - Phone:817-887-8155
Practice Address - Fax:214-645-0078
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630880363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156977401Medicaid
TX8N3680OtherBC/BS
TX8A3459Medicare PIN
TX156977401Medicaid