Provider Demographics
NPI:1780780726
Name:SHEVLIN, LISA E (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:SHEVLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 LINDEN OAKS
Mailing Address - Street 2:SUITE #300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2814
Mailing Address - Country:US
Mailing Address - Phone:585-383-8830
Mailing Address - Fax:585-383-8918
Practice Address - Street 1:360 LINDEN OAKS
Practice Address - Street 2:SUITE #300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2814
Practice Address - Country:US
Practice Address - Phone:585-383-8830
Practice Address - Fax:585-383-8918
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010080363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03124247Medicaid
NYPA0457Medicare ID - Type Unspecified