MEDICARE: ZALIKA OMOROSE' PRYSOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.023928	OH

General Provider Information

NPI Number	:	1295299659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZALIKA OMOROSE' PRYSOCK

Provider Business Mailing Address
First Line	:	5508 SAVINA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-1144
Country	:	US
Telephone Number	:	937-304-5103
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 SAVINA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-1144
Country	:	US
Telephone Number	:	937-304-5103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	02/23/2026

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