Provider Demographics
NPI:1992935258
Name:ZAMUDIO, MARIA ELENA (MA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:MARIELENA
Other - Middle Name:
Other - Last Name:OBRENIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:6072 WILLOWPOINTE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4040
Mailing Address - Country:US
Mailing Address - Phone:407-716-6460
Mailing Address - Fax:
Practice Address - Street 1:6072 WILLOWPOINTE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4040
Practice Address - Country:US
Practice Address - Phone:407-716-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9120559Medicaid