Provider Demographics
NPI:1679995245
Name:CARMONA ZAMORA, SANDY (MD)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:CARMONA ZAMORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-933-1760
Mailing Address - Fax:
Practice Address - Street 1:3071 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1501
Practice Address - Country:US
Practice Address - Phone:407-348-9111
Practice Address - Fax:407-348-9112
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21499208D00000X
FL1316208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice