1518835578 NPI number — BREVARD INDEPENDENT SUPPORTIVE SERVICES LLC

Table of content: KHADER AHMAD ZAHDAN DO (NPI 1023696572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518835578 NPI number — BREVARD INDEPENDENT SUPPORTIVE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREVARD INDEPENDENT SUPPORTIVE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518835578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 LIME ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32926-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-557-2459
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 HARRISON ST STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCOA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32922-7936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-557-2459
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WADE
Authorized Official First Name:
SHIRLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-557-2459

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com