Basic Information
Provider Information
NPI: 1508906314
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCELHANEY
FirstName: SEAN
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5127
Address2:  
City: EVERETT
State: WA
PostalCode: 982065127
CountryCode: US
TelephoneNumber: 4252583900
FaxNumber:  
Practice Location
Address1: 2901 174TH ST NE
Address2:  
City: MARYSVILLE
State: WA
PostalCode: 982714743
CountryCode: US
TelephoneNumber: 4252583900
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/08/2007
LastUpdateDate: 12/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/16/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD00039163WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
876755105WA MEDICAID


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