Healthcare Provider Details

I. General information

NPI: 1750363529
Provider Name (Legal Business Name): SANFORD D. ZELNICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E NOBLE AVE
BUSHNELL FL
33513-5603
US

IV. Provider business mailing address

415 E NOBLE AVE
BUSHNELL FL
33513-5603
US

V. Phone/Fax

Practice location:
  • Phone: 352-569-3100
  • Fax: 352-793-6067
Mailing address:
  • Phone: 352-569-3100
  • Fax: 352-793-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberOS6239
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberOS6239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: