Healthcare Provider Details

I. General information

NPI: 1407723141
Provider Name (Legal Business Name): ZACHARY SHEWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 WHITNEY AVE
HAMDEN CT
06518-3233
US

IV. Provider business mailing address

300 S PINE ISLAND RD STE 243
PLANTATION FL
33324-2631
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax: 203-535-0023
Mailing address:
  • Phone: 954-644-9956
  • Fax: 954-337-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number189047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: