MEDICARE: ZACHARY RICHARD DIONISE

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	208800000X	Urology Physician	ME173648	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558821454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY RICHARD DIONISE

Provider Business Mailing Address
First Line	:	710 LOMAX ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4098
Country	:	US
Telephone Number	:	904-355-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SAINT ELIZABETH WAY STE 145
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-1153
Country	:	US
Telephone Number	:	904-355-6583
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	06/20/2025

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Directions to “ ZACHARY RICHARD DIONISE ” Practice Location

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