Provider Demographics
NPI:1043715469
Name:O'CONNOR, SEAN PATRICK
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:O'CONNOR
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 1:7 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1434
Mailing Address - Country:US
Mailing Address - Phone:203-605-8350
Mailing Address - Fax:
Practice Address - Street 1:501 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1355
Practice Address - Country:US
Practice Address - Phone:203-392-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer