Healthcare Provider Details

I. General information

NPI: 1326963679
Provider Name (Legal Business Name): MEGAN MARIE ZELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W DR MARTIN LUTHER KING JR BLVD STE 105
TAMPA FL
33607-6507
US

IV. Provider business mailing address

5817 MITCHELL MILL RD
WAKE FOREST NC
27587-7259
US

V. Phone/Fax

Practice location:
  • Phone: 656-219-0400
  • Fax:
Mailing address:
  • Phone: 656-219-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: