Provider Demographics
NPI:1912478454
Name:HENDLEY, SEAN M
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:HENDLEY
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 1:11534 ASHTON FIELD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2374
Mailing Address - Country:US
Mailing Address - Phone:813-493-1516
Mailing Address - Fax:813-513-4390
Practice Address - Street 1:11534 ASHTON FIELD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2374
Practice Address - Country:US
Practice Address - Phone:813-493-1516
Practice Address - Fax:813-513-4390
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage