Healthcare Provider Details

I. General information

NPI: 1174082945
Provider Name (Legal Business Name): MICHELLE LUANA ZAYDLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1400 NW 10TH AVE # 16960M851
MIAMI FL
33136-1000
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-7000
  • Fax:
Mailing address:
  • Phone: 305-243-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME163352
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME163352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: