Healthcare Provider Details

I. General information

NPI: 1801433198
Provider Name (Legal Business Name): MS. ZOE MARIE VANCAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4285
US

IV. Provider business mailing address

2062 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4285
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-5576
  • Fax: 321-305-5646
Mailing address:
  • Phone: 321-305-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: