Provider Demographics
NPI:1215618152
Name:FUNDORA CHAVEZ, ZULAY
Entity type:Individual
Prefix:
First Name:ZULAY
Middle Name:
Last Name:FUNDORA CHAVEZ
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 1:323 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1357
Mailing Address - Country:US
Mailing Address - Phone:908-267-4690
Mailing Address - Fax:
Practice Address - Street 1:323 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1357
Practice Address - Country:US
Practice Address - Phone:908-267-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty