Provider Demographics
NPI:1447096961
Name:RAHILLY, SEAN M
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:RAHILLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RHODORA TER
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4721
Mailing Address - Country:US
Mailing Address - Phone:860-818-2019
Mailing Address - Fax:
Practice Address - Street 1:1 RHODORA TER
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4721
Practice Address - Country:US
Practice Address - Phone:860-818-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3032884332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies