Provider Demographics
NPI:1528391711
Name:ZAYAS, MATILDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATILDE
Middle Name:
Last Name:ZAYAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11362 SW 137TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-9101
Mailing Address - Country:US
Mailing Address - Phone:305-383-6336
Mailing Address - Fax:305-383-6336
Practice Address - Street 1:11362 SW 137TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-9101
Practice Address - Country:US
Practice Address - Phone:305-383-6336
Practice Address - Fax:305-383-6336
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH-5221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000865200Medicaid