Basic Information
| Provider Information | |||||||||
| NPI: | 1538125760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACHANDA | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | DEV | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 DORR ST # MS 840 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436154040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194792665 | ||||||||
| FaxNumber: | 4194792639 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 REGENCY CT STE 200 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194792665 | ||||||||
| FaxNumber: | 4194792639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 12/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35084299 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2541511 | 05 | OH | MEDICAID |