Healthcare Provider Details

I. General information

NPI: 1316167083
Provider Name (Legal Business Name): ZULLY E AMBROISE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 LEE RD STE 137
WINTER PARK FL
32789-7229
US

IV. Provider business mailing address

1936 LEE RD STE 137
WINTER PARK FL
32789-7229
US

V. Phone/Fax

Practice location:
  • Phone: 321-207-0623
  • Fax: 321-207-0666
Mailing address:
  • Phone: 321-207-0623
  • Fax: 321-207-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: