Healthcare Provider Details

I. General information

NPI: 1235105966
Provider Name (Legal Business Name): TEDDI THORNBURG ZAYAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TEDDI JANE ZAYAS PA-C

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MOUNTAIN ST
CHERRYVILLE NC
28021-3421
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-5227
  • Fax: 704-435-5233
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003274
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04875
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: