Healthcare Provider Details

I. General information

NPI: 1558773739
Provider Name (Legal Business Name): SHARON ZOLONDEK IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 S LAKESHORE DR #2
TEMPE AZ
85282-7159
US

IV. Provider business mailing address

4703 S LAKESHORE DR #2
TEMPE AZ
85282-7159
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-8491
  • Fax:
Mailing address:
  • Phone: 480-442-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11033288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: