MEDICARE: MS. ZUDAYYAH MEDINA ALAMIN

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	347C00000X	Private Vehicle	T61761700	VA

General Provider Information

NPI Number	:	1376038091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ZUDAYYAH MEDINA ALAMIN

Provider Business Mailing Address
First Line	:	702 AUSTIN CT APT J
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-2792
Country	:	US
Telephone Number	:	757-329-8397
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 AUSTIN CT APT J
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-2792
Country	:	US
Telephone Number	:	757-329-8397
Fax Number	:

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

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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