Healthcare Provider Details

I. General information

NPI: 1073878138
Provider Name (Legal Business Name): ZAKIYA BOMANI MOYENDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10276 OAK MEADOW LN STE 1A
LAKE WORTH FL
33449-5467
US

IV. Provider business mailing address

10276 OAK MEADOW LN STE 1A
LAKE WORTH FL
33449-5467
US

V. Phone/Fax

Practice location:
  • Phone: 954-774-1414
  • Fax:
Mailing address:
  • Phone: 954-774-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME121227
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME121227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: