Provider Demographics
NPI:1316167083
Name:AMBROISE, ZULLY E (MD)
Entity type:Individual
Prefix:DR
First Name:ZULLY
Middle Name:E
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 LEE RD
Mailing Address - Street 2:STE 137
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7229
Mailing Address - Country:US
Mailing Address - Phone:321-207-0623
Mailing Address - Fax:321-207-0666
Practice Address - Street 1:1936 LEE RD
Practice Address - Street 2:STE 137
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7229
Practice Address - Country:US
Practice Address - Phone:321-207-0623
Practice Address - Fax:321-207-0666
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278141700Medicaid