Healthcare Provider Details

I. General information

NPI: 1164953865
Provider Name (Legal Business Name): ROSHINI S ZACHARIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3646
  • Fax:
Mailing address:
  • Phone: 203-735-4090
  • Fax: 203-735-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number075019
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number075019
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: