Provider Demographics
NPI:1366998437
Name:SCHOONOVER, SEAN MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2942
Mailing Address - Country:US
Mailing Address - Phone:307-899-5569
Mailing Address - Fax:
Practice Address - Street 1:1050 MYDLAND RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2186
Practice Address - Country:US
Practice Address - Phone:307-674-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6459363A00000X
WYPT720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant