Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD457437 | PA |
NPI | 1215199799 |
---|---|
Provider Name | Sean S Ciullo |
First Address | Philadelphia, PA 19134-1011 |
Second Address | Philadelphia, PA 19134-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 02/02/2017 |