Healthcare Provider Details

I. General information

NPI: 1295543015
Provider Name (Legal Business Name): ZAYDA COSTA PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 SW 129TH CT
MIAMI FL
33186-4581
US

IV. Provider business mailing address

351 SW 124TH AVE
MIAMI FL
33184-1417
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-3349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: