Provider Demographics
NPI:1144930736
Name:DZAMBA, DEIRDRE ANNE
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANNE
Last Name:DZAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 SW 54TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6667
Mailing Address - Country:US
Mailing Address - Phone:239-671-2881
Mailing Address - Fax:
Practice Address - Street 1:2315 SW 54TH LN
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6667
Practice Address - Country:US
Practice Address - Phone:239-671-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services