Healthcare Provider Details

I. General information

NPI: 1356261275
Provider Name (Legal Business Name): LISSETTE ZEPEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CLARK RD STE 170
SARASOTA FL
34231-8435
US

IV. Provider business mailing address

4870 SW 152ND PL APT G
MIAMI FL
33185-4523
US

V. Phone/Fax

Practice location:
  • Phone: 941-888-2081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: