Provider Demographics
NPI:1649729096
Name:SHEEHAN, LISA (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HOOGSTEDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:30 WEST AVON ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4275
Mailing Address - Country:US
Mailing Address - Phone:860-674-9900
Mailing Address - Fax:860-678-0036
Practice Address - Street 1:30 WEST AVON ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4275
Practice Address - Country:US
Practice Address - Phone:860-674-9900
Practice Address - Fax:860-678-0036
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant