Healthcare Provider Details

I. General information

NPI: 1437796661
Provider Name (Legal Business Name): ZENTHEO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 S NOVA RD STE 101A
ORMOND BEACH FL
32174-8444
US

IV. Provider business mailing address

31 PEBBLE BEACH DR
ORMOND BEACH FL
32174-3887
US

V. Phone/Fax

Practice location:
  • Phone: 386-487-4673
  • Fax:
Mailing address:
  • Phone: 386-986-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE BURROWS
Title or Position: CEO
Credential: MD
Phone: 386-986-0117