Provider Demographics
NPI:1598955973
Name:NDANDU, ZOLA M (MD)
Entity Type:Individual
Prefix:
First Name:ZOLA
Middle Name:M
Last Name:NDANDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PINEHURST POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3703
Mailing Address - Country:US
Mailing Address - Phone:386-232-9203
Mailing Address - Fax:386-222-3064
Practice Address - Street 1:215 HWY 17S
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-4087
Practice Address - Country:US
Practice Address - Phone:386-232-9203
Practice Address - Fax:386-222-3064
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41982207RC0000X, 207RI0011X
LAMD.025861207RI0011X
FLME163287207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1045560Medicaid
FLRK720OtherMEDICARE
MS07571050Medicaid