Healthcare Provider Details

I. General information

NPI: 1326263443
Provider Name (Legal Business Name): SHARON R ZACK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W STATE ROAD 436 SUITE 1061
ALTAMONTE SPRINGS FL
32714-3000
US

IV. Provider business mailing address

13939 WELLINGTON LN
GRAND ISLAND FL
32735-9121
US

V. Phone/Fax

Practice location:
  • Phone: 321-277-7054
  • Fax: 352-357-7200
Mailing address:
  • Phone: 321-277-7054
  • Fax: 352-357-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 43428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: