Healthcare Provider Details

I. General information

NPI: 1689505224
Provider Name (Legal Business Name): ZUZEL QUIALA HASTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 PEGGY WAY UNIT B
BARTOW FL
33830-9522
US

IV. Provider business mailing address

4310 PEGGY WAY UNIT B
BARTOW FL
33830-9522
US

V. Phone/Fax

Practice location:
  • Phone: 980-213-6426
  • Fax:
Mailing address:
  • Phone: 980-213-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26537810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: