Provider Demographics
NPI:1659952513
Name:WASIELCZYK, ZOBIA ZAFAR (PA)
Entity Type:Individual
Prefix:
First Name:ZOBIA
Middle Name:ZAFAR
Last Name:WASIELCZYK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ZOBIA
Other - Middle Name:
Other - Last Name:ZAFAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1108 W INDIAN SCHOOL RD STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3115
Mailing Address - Country:US
Mailing Address - Phone:602-773-5600
Mailing Address - Fax:602-773-5601
Practice Address - Street 1:3552 W BASELINE RD STE 140
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3042
Practice Address - Country:US
Practice Address - Phone:602-635-6951
Practice Address - Fax:602-635-6952
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ9554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program