Provider Demographics
NPI:1750363529
Name:ZELNICK, SANFORD D (DO)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:D
Last Name:ZELNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5603
Mailing Address - Country:US
Mailing Address - Phone:352-569-3100
Mailing Address - Fax:352-793-6067
Practice Address - Street 1:415 E NOBLE AVE
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5603
Practice Address - Country:US
Practice Address - Phone:352-569-3100
Practice Address - Fax:352-793-6067
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS62392083P0500X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
92318OtherCOMMERCIAL
FL265470900Medicaid
92318OtherCOMMERCIAL