Provider Demographics
NPI:1245591346
Name:CAMACHO, ZHANDRA (MSSP ED)
Entity Type:Individual
Prefix:MS
First Name:ZHANDRA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MSSP ED
Other - Prefix:
Other - First Name:ZHANDRA
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 VAN ZANT ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1717
Mailing Address - Country:US
Mailing Address - Phone:718-812-2008
Mailing Address - Fax:
Practice Address - Street 1:5 VAN ZANT ST
Practice Address - Street 2:UNIT 2
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1717
Practice Address - Country:US
Practice Address - Phone:718-812-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist