MEDICARE: ZACHARY R GROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1104757061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY R GROSE

Provider Business Mailing Address
First Line	:	3930 FLOWERING STREAM WAY
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32766-8662
Country	:	US
Telephone Number	:	407-409-4945
Fax Number	:

Provider Business Practice Location Address
First Line	:	13538 VILLAGE PARK DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7698
Country	:	US
Telephone Number	:	407-730-2948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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