Healthcare Provider Details

I. General information

NPI: 1265345078
Provider Name (Legal Business Name): ZAIRA DOUGHTY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PARKWAY STE 204
BROOMALL PA
19008-4202
US

IV. Provider business mailing address

837 N 26TH ST
PHILADELPHIA PA
19130-1822
US

V. Phone/Fax

Practice location:
  • Phone: 610-353-5332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: