Healthcare Provider Details

I. General information

NPI: 1356966782
Provider Name (Legal Business Name): STACY ZEBRICK EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10144 ARBOR RUN DR UNIT 128
TAMPA FL
33647-3570
US

IV. Provider business mailing address

10144 ARBOR RUN DR UNIT 128
TAMPA FL
33647-3570
US

V. Phone/Fax

Practice location:
  • Phone: 954-937-6253
  • Fax:
Mailing address:
  • Phone: 954-937-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: