Healthcare Provider Details

I. General information

NPI: 1548061682
Provider Name (Legal Business Name): INFECTIOUS DISEASE DOCTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 05/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTHCARE BLVD
ST AUGUSTINE FL
32086-0400
US

IV. Provider business mailing address

400 MOULTRIE LANDING UNIT 9205
ST AUGUSTINE FL
32086-6184
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-2808
  • Fax: 904-679-3169
Mailing address:
  • Phone: 904-547-2808
  • Fax: 904-679-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DANI ZAVASKY
Title or Position: OWNER
Credential: MD
Phone: 917-526-2311