Healthcare Provider Details

I. General information

NPI: 1477460418
Provider Name (Legal Business Name): DAVID DESHEFY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MONTAUK AVE
NEW LONDON CT
06320-4769
US

IV. Provider business mailing address

47 CEDAR LN
BOZRAH CT
06334-1311
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-0711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number002417
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: