Healthcare Provider Details

I. General information

NPI: 1255728341
Provider Name (Legal Business Name): ZULEMA ZAMORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 06/17/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 ORANGE DR STE 502
DAVIE FL
33330-4306
US

IV. Provider business mailing address

221 SW 97TH TER
PEMBROKE PINES FL
33025-1055
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8048
  • Fax:
Mailing address:
  • Phone: 786-357-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI3252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: