Healthcare Provider Details

I. General information

NPI: 1104442888
Provider Name (Legal Business Name): ZACHARY F DANSSAERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

IV. Provider business mailing address

129 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 858-342-4833
  • Fax:
Mailing address:
  • Phone: 860-972-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number84628
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: