Provider Demographics
NPI:1720333602
Name:BERTRAND-ZELAYA, SARAH B (MED)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:B
Last Name:BERTRAND-ZELAYA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:B
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1355 MARIPOSA CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-7259
Mailing Address - Country:US
Mailing Address - Phone:603-738-9369
Mailing Address - Fax:
Practice Address - Street 1:1355 MARIPOSA CIR APT 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-7259
Practice Address - Country:US
Practice Address - Phone:603-738-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-10161103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst