Healthcare Provider Details

I. General information

NPI: 1881295798
Provider Name (Legal Business Name): PALUMBO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26236 US HIGHWAY 19 N
CLEARWATER FL
33761-3580
US

IV. Provider business mailing address

26236 US HIGHWAY 19 N
CLEARWATER FL
33761-3580
US

V. Phone/Fax

Practice location:
  • Phone: 727-953-3599
  • Fax: 727-953-6808
Mailing address:
  • Phone: 727-953-3599
  • Fax: 727-953-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PALUMBO
Title or Position: PHYSICIAN
Credential: MD
Phone: 727-439-0961