Provider Demographics
NPI:1376657775
Name:ZALEWA, MICHAEL JOSEPH
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ZALEWA
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 1:2303 SAWGRASS VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5008
Mailing Address - Country:US
Mailing Address - Phone:904-273-6894
Mailing Address - Fax:904-273-6895
Practice Address - Street 1:2303 SAWGRASS VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5008
Practice Address - Country:US
Practice Address - Phone:904-273-6894
Practice Address - Fax:904-273-6895
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health