Provider Demographics
NPI:1750342242
Name:HENNESSEY, SEAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:HENNESSEY
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 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:#304
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2580
Practice Address - Country:US
Practice Address - Phone:707-643-6483
Practice Address - Fax:707-643-3028
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA02736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH1746760OtherDEA
A02736Medicare UPIN
CAYYY48297YMedicare PIN