Provider Demographics
NPI:1184848566
Name:ZAMBANINI, BRADLEY MARK (MA)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:MARK
Last Name:ZAMBANINI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 2ND ST. NW
Mailing Address - Street 2:#GL03
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001
Mailing Address - Country:US
Mailing Address - Phone:202-421-6604
Mailing Address - Fax:
Practice Address - Street 1:2035 2ND ST NW
Practice Address - Street 2:GL03
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5604
Practice Address - Country:US
Practice Address - Phone:202-421-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000118235Z00000X
VA2202006254235Z00000X
CA11387235Z00000X
MD05536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist