MEDICARE: LISA E SHAKUN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	013444	NY
2	363A00000X	Physician Assistant	PA7540	MA
3	363A00000X	Physician Assistant	002236	CT

General Provider Information

NPI Number	:	1154561884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA E SHAKUN PA-C

Provider Business Mailing Address
First Line	:	31 OLD ROUTE 7
Second Line	:
City	:	BROOKFIELD
State	:	CT
Zip	:	06804-1711
Country	:	US
Telephone Number	:	860-650-3848
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 MIDDLE TPKE W
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06040-3824
Country	:	US
Telephone Number	:	860-650-3848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	03/12/2025

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Directions to “ LISA E SHAKUN PA-C” Practice Location

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