Provider Demographics
NPI:1518193457
Name:ZACCHILLI, JANEL HEATHER (DO)
Entity Type:Individual
Prefix:DR
First Name:JANEL
Middle Name:HEATHER
Last Name:ZACCHILLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3439
Mailing Address - Country:US
Mailing Address - Phone:718-833-2300
Mailing Address - Fax:718-836-2305
Practice Address - Street 1:7715 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3439
Practice Address - Country:US
Practice Address - Phone:718-833-2300
Practice Address - Fax:718-836-2305
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263014208000000X
NC201201552208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518193457Medicaid