Provider Demographics
NPI:1669706578
Name:ZAKI, SHAHZAD (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:
Last Name:ZAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1737
Mailing Address - Country:US
Mailing Address - Phone:203-626-5393
Mailing Address - Fax:203-626-5527
Practice Address - Street 1:1257 S BROAD ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1737
Practice Address - Country:US
Practice Address - Phone:203-626-5393
Practice Address - Fax:203-626-5527
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051335261QU0200X, 207Q00000X
NY254500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care