Healthcare Provider Details

I. General information

NPI: 1225612567
Provider Name (Legal Business Name): GALORE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7522 WILES RD STE B201
CORAL SPRINGS FL
33067-2062
US

IV. Provider business mailing address

7522 WILES RD STE B201
CORAL SPRINGS FL
33067-2062
US

V. Phone/Fax

Practice location:
  • Phone: 954-488-2013
  • Fax: 305-402-0941
Mailing address:
  • Phone: 954-488-2013
  • Fax: 305-402-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SHENIDA DESIR
Title or Position: OWNER
Credential: NP
Phone: 305-418-0580