Healthcare Provider Details

I. General information

NPI: 1033763958
Provider Name (Legal Business Name): ALEXANDRA DEANNA ZAK PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BROAD ST
GUILFORD CT
06437-2603
US

IV. Provider business mailing address

152 BROAD ST
GUILFORD CT
06437-2603
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-5235
  • Fax: 203-453-6204
Mailing address:
  • Phone: 203-453-5235
  • Fax: 203-453-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10953
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10953
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10953
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: