Provider Demographics
NPI:1295620425
Name:ZAGOTTA, AMELIA ELIZABETH
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELIZABETH
Last Name:ZAGOTTA
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 1:4063 CANTERBERRY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8176
Mailing Address - Country:US
Mailing Address - Phone:248-392-0559
Mailing Address - Fax:
Practice Address - Street 1:426 N INGALLS ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2003
Practice Address - Country:US
Practice Address - Phone:734-763-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704417545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse