Provider Demographics
NPI:1891570602
Name:ZAJAC, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 NW 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3721
Mailing Address - Country:US
Mailing Address - Phone:954-649-6775
Mailing Address - Fax:
Practice Address - Street 1:5757 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4135
Practice Address - Country:US
Practice Address - Phone:954-734-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health