Healthcare Provider Details

I. General information

NPI: 1720894199
Provider Name (Legal Business Name): ZODU THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W SR 434 STE 1000
LONGWOOD FL
32750-4969
US

IV. Provider business mailing address

1250 W SR 434 STE 1000
LONGWOOD FL
32750-4969
US

V. Phone/Fax

Practice location:
  • Phone: 689-304-9638
  • Fax:
Mailing address:
  • Phone: 689-304-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL E DUANY
Title or Position: OWNER
Credential:
Phone: 973-986-6595