Healthcare Provider Details

I. General information

NPI: 1174454300
Provider Name (Legal Business Name): ZOREED ALI MUKHTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

14525 SAN LORENZO DR
ORLANDO FL
32820-1433
US

V. Phone/Fax

Practice location:
  • Phone: 423-685-9051
  • Fax:
Mailing address:
  • Phone: 732-500-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPDL8683
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: