Provider Demographics
NPI:1134852999
Name:RUDDELL, ZAYNAH
Entity type:Individual
Prefix:
First Name:ZAYNAH
Middle Name:
Last Name:RUDDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4113
Mailing Address - Country:US
Mailing Address - Phone:727-505-3670
Mailing Address - Fax:
Practice Address - Street 1:11956 RUDDY RUN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4096
Practice Address - Country:US
Practice Address - Phone:727-505-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst