Provider Demographics
NPI:1912369026
Name:O'DANIEL, SEAN RYAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:RYAN
Last Name:O'DANIEL
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 1:2325 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3300
Mailing Address - Country:US
Mailing Address - Phone:316-371-8945
Mailing Address - Fax:
Practice Address - Street 1:1312 17TH ST
Practice Address - Street 2:SUITE 146
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1508
Practice Address - Country:US
Practice Address - Phone:720-982-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator