Provider Demographics
NPI:1215405568
Name:DEMETRIOU, ZACHARY JOHN
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JOHN
Last Name:DEMETRIOU
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 1:3710 SW 48TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-8256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21150 BISCAYNE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1231
Practice Address - Country:US
Practice Address - Phone:954-482-4747
Practice Address - Fax:954-301-5939
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical