MEDICARE: CHELSEY GALLEGOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9115878	FL
2	363A00000X	Physician Assistant	PA213471	OR

General Provider Information

NPI Number	:	1265149165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY GALLEGOS

Provider Business Mailing Address
First Line	:	103 SOLANA RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2231
Country	:	US
Telephone Number	:	904-273-2717
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 SOLANA RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2231
Country	:	US
Telephone Number	:	904-273-2717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	05/29/2026

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