Healthcare Provider Details

I. General information

NPI: 1104236199
Provider Name (Legal Business Name): SEAN WAYNE LAZARUS D.P.M. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 CAMPELLE AVE UNITG
WEST HAVEN CT
06516-3786
US

IV. Provider business mailing address

764 CAMPELLE AVE UNIT G
WEST HAVEN CT
06516-3786
US

V. Phone/Fax

Practice location:
  • Phone: 475-238-7400
  • Fax: 475-238-7400
Mailing address:
  • Phone: 475-238-7400
  • Fax: 475-238-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN WAYNE LAZARUS
Title or Position: DOCTOR
Credential: D.P.M
Phone: 203-453-0704