Healthcare Provider Details

I. General information

NPI: 1487271680
Provider Name (Legal Business Name): ZACHARY LEONE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OAKLAND RD STE 1
SOUTH WINDSOR CT
06074-2897
US

IV. Provider business mailing address

25 OAKLAND RD STE 1
SOUTH WINDSOR CT
06074-2897
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-5628
  • Fax: 860-648-1107
Mailing address:
  • Phone: 860-644-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4926
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: