Provider Demographics
NPI:1619975919
Name:SHEA, LISA A (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:SHEA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:ZAPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:82 NEW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH FRANKLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06254-1807
Mailing Address - Country:US
Mailing Address - Phone:860-889-7345
Mailing Address - Fax:860-885-7225
Practice Address - Street 1:82 NEW PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254-1807
Practice Address - Country:US
Practice Address - Phone:860-889-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000042Medicare ID - Type UnspecifiedPROVIDER NUMBER
970000042Medicare PIN
CTS31889Medicare UPIN
S31889Medicare PIN