Healthcare Provider Details

I. General information

NPI: 1235055716
Provider Name (Legal Business Name): MICHELLE CHRISTINE ZOLTAN-GARROVILLAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY
LATHAM NY
12110-2156
US

IV. Provider business mailing address

33 MARION AVE
ALBANY NY
12203-1822
US

V. Phone/Fax

Practice location:
  • Phone: 518-980-9040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11048491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: