MEDICARE: FAITH SELECT ZOLFAGHARI

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	163W00000X	Registered Nurse	9365224	FL
2	363LF0000X	Family Nurse Practitioner	11007314	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386269017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH SELECT ZOLFAGHARI

Provider Business Mailing Address
First Line	:	4930 E LAKE MARY BLVD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-5003
Country	:	US
Telephone Number	:	407-322-8645
Fax Number	:	407-269-8986

Provider Business Practice Location Address
First Line	:	1120 STATE ROAD 436 STE 1600
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-6182
Country	:	US
Telephone Number	:	407-322-8645
Fax Number	:	407-269-8986

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

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	11/10/2020

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Directions to “ FAITH SELECT ZOLFAGHARI ” Practice Location

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