Provider Demographics
NPI:1083171201
Name:O'CONNOR, SEAN RAYMOND (PA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:RAYMOND
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:072-712-0506
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1676
Practice Address - Country:US
Practice Address - Phone:607-737-4508
Practice Address - Fax:607-735-5738
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2023-03-02
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Provider Licenses
StateLicense IDTaxonomies
NY027705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant