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General NPI Number Information
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NPI Number | 1730631037
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Entity Type | Organization
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Legal Business Name | MILLENNIUM WELLNESS CENTER
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 110 N FEDERAL HWY 104
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4300
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Country | US
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Telephone | 305-417-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 110 N FEDERAL HWY 104
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4300
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Country | US
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Telephone | 305-417-0006
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ZHANNA ZITSBANK
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Credential | PA-C
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Telephone | 305-417-0006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9104275
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 8220
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License Number State | FL
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