Healthcare Provider Details

I. General information

NPI: 1356093769
Provider Name (Legal Business Name): JADY ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 ALTERNATE A1A STE 707
PALM BEACH GARDENS FL
33410-4937
US

IV. Provider business mailing address

3359 GARDENS EAST DR APT B
PALM BEACH GARDENS FL
33410-4950
US

V. Phone/Fax

Practice location:
  • Phone: 201-961-2719
  • Fax:
Mailing address:
  • Phone: 561-878-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberSL3400355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: