Provider Demographics
NPI:1902635360
Name:ZAFERATOS, MADISON MCKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MCKENZIE
Last Name:ZAFERATOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SOUTHERLY PARC LN APT 7-109
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8071
Mailing Address - Country:US
Mailing Address - Phone:336-596-7376
Mailing Address - Fax:
Practice Address - Street 1:1200 DELTONA BLVD APT 40A
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-6386
Practice Address - Country:US
Practice Address - Phone:386-202-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119062363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical