Healthcare Provider Details

I. General information

NPI: 1952554750
Provider Name (Legal Business Name): MRS. WENDY R ZEBALLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 PINE MARSH LOOP
SAINT CLOUD FL
34771-7407
US

IV. Provider business mailing address

1557 PINE MARSH LOOP
SAINT CLOUD FL
34771
US

V. Phone/Fax

Practice location:
  • Phone: 407-242-5320
  • Fax:
Mailing address:
  • Phone: 407-242-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: