Healthcare Provider Details

I. General information

NPI: 1023750759
Provider Name (Legal Business Name): SEAN LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CORPORATE DR STE 2-1
TRUMBULL CT
06611-1351
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 203-459-5100
  • Fax: 203-452-2424
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84739
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: