Provider Demographics
NPI:1598464885
Name:ZAMUDIO, DESTINY NIKOLE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:NIKOLE
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-5635
Mailing Address - Country:US
Mailing Address - Phone:816-482-2779
Mailing Address - Fax:
Practice Address - Street 1:7005 HUNTER ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5635
Practice Address - Country:US
Practice Address - Phone:816-482-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician