Healthcare Provider Details

I. General information

NPI: 1619991981
Provider Name (Legal Business Name): SEAN WAYNE LAZARUS D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 CAMPBELL AVE SUITE G
WEST HAVEN CT
06516-3786
US

IV. Provider business mailing address

764 CAMPBELL AVE SUITE G
WEST HAVEN CT
06516-3786
US

V. Phone/Fax

Practice location:
  • Phone: 475-238-7400
  • Fax: 475-238-7982
Mailing address:
  • Phone: 475-238-7400
  • Fax: 475-238-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000642
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000642
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: