Provider Demographics
NPI:1780100735
Name:CEPHAS, ZANDRA E (ASPT,CPT)
Entity type:Individual
Prefix:
First Name:ZANDRA
Middle Name:E
Last Name:CEPHAS
Suffix:
Gender:F
Credentials:ASPT,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-2005
Mailing Address - Country:US
Mailing Address - Phone:410-726-6573
Mailing Address - Fax:410-831-3548
Practice Address - Street 1:202 HOLLY ST
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826-2005
Practice Address - Country:US
Practice Address - Phone:410-726-6573
Practice Address - Fax:410-831-3548
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD681104140001156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist