Provider Demographics
NPI:1154163715
Name:EDWARDS, ZAKEYIA
Entity type:Individual
Prefix:
First Name:ZAKEYIA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N 55TH AVE STE 102-250
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1321
Mailing Address - Country:US
Mailing Address - Phone:602-686-5796
Mailing Address - Fax:
Practice Address - Street 1:7800 N 55TH AVE STE 102-250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1321
Practice Address - Country:US
Practice Address - Phone:602-686-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)