Healthcare Provider Details

I. General information

NPI: 1831043132
Provider Name (Legal Business Name): ZACHARY EDOUARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 W DIXIE HWY
NORTH MIAMI FL
33161-4131
US

IV. Provider business mailing address

415 NE 142ND ST
NORTH MIAMI FL
33161-3130
US

V. Phone/Fax

Practice location:
  • Phone: 786-442-5021
  • Fax: 786-921-0041
Mailing address:
  • Phone: 786-442-5021
  • Fax: 786-921-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9703457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: