Provider Demographics
NPI:1740218510
Name:ZAVODNICK, JACQUELYN M (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:M
Last Name:ZAVODNICK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1655 OAKWOOD DR
Mailing Address - Street 2:N122
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1017
Mailing Address - Country:US
Mailing Address - Phone:610-668-9997
Mailing Address - Fax:610-296-5866
Practice Address - Street 1:1041 W BRIDGE ST
Practice Address - Street 2:STES 1 & 2, DEVEREUX BENETO CTR COMM SVCS DEVEREUX
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-933-8110
Practice Address - Fax:610-296-5866
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD015911E2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005544390339Medicaid
PA0005544390339Medicaid