Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 9247 | SC |
N | 213EG0000X | General Practice | 9247 | SC |
Y | 1223P0221X | Pediatric Dentist | 993 | SC |
NPI | 1043664287 |
---|---|
Provider Name | Dr. Amy Zelko |
First Address | Waukesha, WI 53189-9774 |
Second Address | Walterboro, SC 29488-6817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 11/01/2020 |