Provider Demographics
NPI:1720607815
Name:REILLY, SEAN PATRICK
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:REILLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3603
Mailing Address - Country:US
Mailing Address - Phone:203-733-0228
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST STE 301
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4405
Practice Address - Country:US
Practice Address - Phone:215-995-2363
Practice Address - Fax:215-995-8600
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program