Individual
SEAN ERVIN LISK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-2615
Mailing address
191 SPRING ST, SOUTH SALEM, NY 10590-1615
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3811
CT
363AM0700X
Medical Physician Assistant
PA1495
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104252972
—
ME
Enumeration date
09/24/2013
Last updated
12/28/2021
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