Healthcare Provider Details

I. General information

NPI: 1063475739
Provider Name (Legal Business Name): MICHAEL FRANCIS ZODA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 KILLEARN CENTER BLVD SUITE C2
TALLAHASSEE FL
32309-3467
US

IV. Provider business mailing address

1535 KILLEARN CENTER BLVD SUITE C2
TALLAHASSEE FL
32309-3467
US

V. Phone/Fax

Practice location:
  • Phone: 850-668-2959
  • Fax: 850-894-9957
Mailing address:
  • Phone: 850-668-2959
  • Fax: 850-894-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: