Healthcare Provider Details

I. General information

NPI: 1679354914
Provider Name (Legal Business Name): SEAN THOMAS ZIPAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53652 HERITAGE LN
CHESTERFIELD MI
48047-5849
US

IV. Provider business mailing address

53652 HERITAGE LN
CHESTERFIELD MI
48047-5849
US

V. Phone/Fax

Practice location:
  • Phone: 586-405-0067
  • Fax:
Mailing address:
  • Phone: 586-405-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704286894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: