Healthcare Provider Details

I. General information

NPI: 1104566033
Provider Name (Legal Business Name): JESSICA ZURLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6843
US

IV. Provider business mailing address

15 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6843
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL88017
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: