Provider Demographics
NPI:1750036646
Name:COVELLO, LISA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:COVELLO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:14 APPLEBEE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3513
Mailing Address - Country:US
Mailing Address - Phone:203-921-9709
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD STE 220
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1230
Practice Address - Country:US
Practice Address - Phone:203-658-6051
Practice Address - Fax:888-397-2148
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant