Healthcare Provider Details

I. General information

NPI: 1053286823
Provider Name (Legal Business Name): TRANSFORMATIONAL LIFE CONSULTING MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E ELEANA LN
GILBERT AZ
85298-5776
US

IV. Provider business mailing address

1400 VILLAGE SQUARE BLVD # 3-85340
TALLAHASSEE FL
32312-1250
US

V. Phone/Fax

Practice location:
  • Phone: 850-296-5091
  • Fax:
Mailing address:
  • Phone: 850-296-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEEPA GRANDON
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 850-296-5091