Provider Demographics
NPI:1487869400
Name:CASTELLUCCI, SEAN ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ALEXANDER
Last Name:CASTELLUCCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:200 3RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-792-0340
Practice Address - Fax:941-794-2251
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013044208800000X
FLOS11276208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14EH4OtherBCBS FL
FL236008OtherUNVERSAL HEALTHCARE
FLP939461OtherOPTIMUM
FLP01800301OtherCLEAR HEALTH
FLP993826OtherFREEDOM HEALTH
FL529659OtherWELLCARE
FLP01042688OtherRAILROAD MCR
FL353765OtherAVMED
FL9213454OtherAETNA
FLP01042688OtherRAILROAD MCR