Provider Demographics
NPI:1063126522
Name:SMITH, ZACHARY DAVID (NP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STANDART AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1509
Mailing Address - Country:US
Mailing Address - Phone:315-255-1100
Mailing Address - Fax:315-255-1322
Practice Address - Street 1:144 STANDART AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1509
Practice Address - Country:US
Practice Address - Phone:315-255-1100
Practice Address - Fax:315-255-1322
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner