Basic Information
| Provider Information | |||||||||
| NPI: | 1487869400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTELLUCCI | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: PAYER CONTRACTING & RELATIONS | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 3RD AVE W | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342058626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417920340 | ||||||||
| FaxNumber: | 9417942251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2007 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | OS013044 | PA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | OS11276 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 14EH4 | 01 | FL | BCBS FL | OTHER | 236008 | 01 | FL | UNVERSAL HEALTHCARE | OTHER | P939461 | 01 | FL | OPTIMUM | OTHER | P01800301 | 01 | FL | CLEAR HEALTH | OTHER | P993826 | 01 | FL | FREEDOM HEALTH | OTHER | 529659 | 01 | FL | WELLCARE | OTHER | P01042688 | 01 | FL | RAILROAD MCR | OTHER | 353765 | 01 | FL | AVMED | OTHER | 9213454 | 01 | FL | AETNA | OTHER |