Healthcare Provider Details

I. General information

NPI: 1669030409
Provider Name (Legal Business Name): ASHVIN BABU ZACHARIAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

621 W LUMSDEN RD
BRANDON FL
33511-5911
US

V. Phone/Fax

Practice location:
  • Phone: 813-755-3500
  • Fax: 813-755-3300
Mailing address:
  • Phone: 813-755-3500
  • Fax: 813-755-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME170447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: