Healthcare Provider Details

I. General information

NPI: 1831690106
Provider Name (Legal Business Name): MICHELLE ZAMORA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 MEADOWLANE AVE
MELBOURNE FL
32904-4950
US

IV. Provider business mailing address

14001 SW 105TH ST
MIAMI FL
33186-3124
US

V. Phone/Fax

Practice location:
  • Phone: 321-467-4848
  • Fax: 321-985-0329
Mailing address:
  • Phone: 305-308-6226
  • Fax: 321-985-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA57712
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: