Healthcare Provider Details

I. General information

NPI: 1356176143
Provider Name (Legal Business Name): ZODIAC INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SPRING CENTRE SOUTH BLVD STE 221
ALTAMONTE SPRINGS FL
32714-1955
US

IV. Provider business mailing address

2531 SUGARSAND CT
APOPKA FL
32712-5040
US

V. Phone/Fax

Practice location:
  • Phone: 321-297-5003
  • Fax:
Mailing address:
  • Phone: 407-616-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER T MCSHAN
Title or Position: DIRECTOR
Credential:
Phone: 321-297-5003