Provider Demographics
NPI:1598321978
Name:WASAO, ZELDA SHIMBA (MD)
Entity Type:Individual
Prefix:
First Name:ZELDA
Middle Name:SHIMBA
Last Name:WASAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAUREL OAK RD STE B
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4453
Mailing Address - Country:US
Mailing Address - Phone:856-513-4124
Mailing Address - Fax:
Practice Address - Street 1:10301 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7701
Practice Address - Country:US
Practice Address - Phone:915-595-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA11891500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program