Healthcare Provider Details

I. General information

NPI: 1013876812
Provider Name (Legal Business Name): DOMINIC ZHENG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

IV. Provider business mailing address

PO BOX 20802
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-5255
  • Fax: 561-844-5245
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: