Provider Demographics
NPI:1376885517
Name:ZELNA, BRENDON TAYLOR
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:TAYLOR
Last Name:ZELNA
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 1:6450 38TH AVE N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-347-8872
Mailing Address - Fax:727-343-6670
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SUITE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-347-8872
Practice Address - Fax:727-343-6670
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3745213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist