Provider Demographics
NPI:1831690106
Name:ZAMORA, MICHELLE (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 SW 105TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3124
Mailing Address - Country:US
Mailing Address - Phone:305-308-6226
Mailing Address - Fax:321-985-0329
Practice Address - Street 1:2070 MEADOWLANE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4950
Practice Address - Country:US
Practice Address - Phone:321-467-4848
Practice Address - Fax:321-985-0329
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57712225700000X
FLAP3191171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty