Healthcare Provider Details

I. General information

NPI: 1881221463
Provider Name (Legal Business Name): NOTHANDO ZIBANAYI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WATERMAN WAY
TAVARES FL
32778-5266
US

IV. Provider business mailing address

901 STERTHAUS DR
ORMOND BEACH FL
32174-5133
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-3333
  • Fax:
Mailing address:
  • Phone: 352-253-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number162509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: