Provider Demographics
NPI:1881437705
Name:ZAYIC, MYLES RONALD (LADC)
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:RONALD
Last Name:ZAYIC
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0647
Mailing Address - Country:US
Mailing Address - Phone:507-923-9285
Mailing Address - Fax:
Practice Address - Street 1:2360 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4065
Practice Address - Country:US
Practice Address - Phone:507-282-0142
Practice Address - Fax:507-282-6261
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307052101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)