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General NPI Number Information
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NPI Number | 1104757061
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Entity Type | Individual
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Provider Name | ZACHARY R GROSE
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Gender | Male
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Dates
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Enumeration Date | 05/28/2026
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Last Update Date | 05/28/2026
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Provider Practice Location Address
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Address Line | 13538 VILLAGE PARK DR
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City | ORLANDO
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State | FL
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Zip | 32837-7698
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Country | US
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Telephone | 407-730-2948
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 FLOWERING STREAM WAY
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City | OVIEDO
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State | FL
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Zip | 32766-8662
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Country | US
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Telephone | 407-409-4945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | FL
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