Healthcare Provider Details

I. General information

NPI: 1790256832
Provider Name (Legal Business Name): SHYAM ZAVERI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 S DIXIE HWY STE 12687
PINECREST FL
33156-5975
US

IV. Provider business mailing address

6520 SW 98TH ST
MIAMI FL
33156-3341
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-4579
  • Fax:
Mailing address:
  • Phone: 305-793-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34147
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: