Provider Demographics
NPI:1902185671
Name:ZACHAR, BRENDAN A (AP)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:A
Last Name:ZACHAR
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 US HIGHWAY 1 STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3722
Mailing Address - Country:US
Mailing Address - Phone:321-802-1046
Mailing Address - Fax:
Practice Address - Street 1:1978 US HIGHWAY 1 STE 107
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3722
Practice Address - Country:US
Practice Address - Phone:321-802-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2865171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1902185671Medicare PIN