Basic Information
Provider Information | |||||||||
NPI: | 1538101522 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCFADDEN | ||||||||
FirstName: | SEAN | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3451 TECHNOLOGICAL AVE STE 15 | ||||||||
Address2: |   | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328178353 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073808705 | ||||||||
FaxNumber: | 4076432804 | ||||||||
Practice Location | |||||||||
Address1: | 3451 TECHNOLOGICAL AVE STE 15 | ||||||||
Address2: |   | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328178353 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073808705 | ||||||||
FaxNumber: | 4076432804 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2006 | ||||||||
LastUpdateDate: | 11/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | OS8094 | FL | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 7461358 | 01 | FL | AETNA PPO | OTHER | 264384700 | 05 | FL |   | MEDICAID | 3717683 | 01 | FL | AETNA HMO | OTHER | 12485 | 01 | FL | FHHS PROVIDER NUMBER | OTHER | 280549 | 01 | FL | AVMED PROVIDER NUMBER | OTHER | 0109468 | 01 | FL | UHC PROVIDER NUMBER | OTHER | 58858 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 9671701004 | 01 | FL | CIGNA PROVIDER NUMBER | OTHER |