Provider Demographics
NPI:1558821454
Name:DIONISE, ZACHARY RICHARD
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RICHARD
Last Name:DIONISE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LOMAX ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4098
Mailing Address - Country:US
Mailing Address - Phone:904-355-6583
Mailing Address - Fax:
Practice Address - Street 1:300 SAINT ELIZABETH WAY STE 145
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-1153
Practice Address - Country:US
Practice Address - Phone:904-355-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME173648208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program