Healthcare Provider Details

I. General information

NPI: 1487497236
Provider Name (Legal Business Name): ZACHARY SHERY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVE
MONTCLAIR NJ
07042-4837
US

IV. Provider business mailing address

1 BAY AVE
MONTCLAIR NJ
07042-4837
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-6775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15595300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: