Healthcare Provider Details

I. General information

NPI: 1366963209
Provider Name (Legal Business Name): KRISTEN MARIE ZANKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARIE SHUSHTARI M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 209
HOLLYWOOD FL
33026-1531
US

IV. Provider business mailing address

1700 SW 10TH CT
FORT LAUDERDALE FL
33312-3243
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-5437
  • Fax: 954-432-0202
Mailing address:
  • Phone: 727-365-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: