Provider Demographics
NPI:1902206808
Name:MARRERO, ZAYRA YAENIS I (SLP)
Entity Type:Individual
Prefix:MISS
First Name:ZAYRA
Middle Name:YAENIS
Last Name:MARRERO
Suffix:I
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PERTH PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:34758
Mailing Address - Country:UM
Mailing Address - Phone:407-705-8070
Mailing Address - Fax:
Practice Address - Street 1:2701 MICHIGAN AVE STE C
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1214
Practice Address - Country:US
Practice Address - Phone:407-513-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2050235Z00000X
FLSA 13797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017631200Medicaid