Provider Demographics
NPI:1699438903
Name:MITHAVAYANI, ZAFARULLA A
Entity type:Individual
Prefix:
First Name:ZAFARULLA
Middle Name:A
Last Name:MITHAVAYANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 RIVERSIDE DR APT 407
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7022
Mailing Address - Country:US
Mailing Address - Phone:786-909-4567
Mailing Address - Fax:
Practice Address - Street 1:1801 N UNIVERSITY DR STE 209
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6078
Practice Address - Country:US
Practice Address - Phone:786-909-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty