Provider Demographics
NPI:1851100788
Name:ZWACK, MAYA NAOMI (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:NAOMI
Last Name:ZWACK
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 15TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-5356
Mailing Address - Country:US
Mailing Address - Phone:941-889-9049
Mailing Address - Fax:
Practice Address - Street 1:312 S BREVARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2214
Practice Address - Country:US
Practice Address - Phone:941-889-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist