Healthcare Provider Details

I. General information

NPI: 1114882966
Provider Name (Legal Business Name): BROOKE ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30217 ROBERT ST
WICKLIFFE OH
44092-1719
US

IV. Provider business mailing address

30217 ROBERT ST
WICKLIFFE OH
44092-1719
US

V. Phone/Fax

Practice location:
  • Phone: 440-391-8159
  • Fax:
Mailing address:
  • Phone: 440-391-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: