Healthcare Provider Details

I. General information

NPI: 1184145609
Provider Name (Legal Business Name): KACEY SABRA ZILBERBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 E JEFFERSON ST
ORLANDO FL
32801-2144
US

IV. Provider business mailing address

1504 E JEFFERSON ST
ORLANDO FL
32801-2144
US

V. Phone/Fax

Practice location:
  • Phone: 305-773-8156
  • Fax:
Mailing address:
  • Phone: 561-699-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9110491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: