Healthcare Provider Details

I. General information

NPI: 1346626462
Provider Name (Legal Business Name): MY ALLERGY LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S CONGRESS AVE SUITE 103
DELRAY BEACH FL
33445-6300
US

IV. Provider business mailing address

1615 S CONGRESS AVE SUITE 103
DELRAY BEACH FL
33445-6300
US

V. Phone/Fax

Practice location:
  • Phone: 239-308-9028
  • Fax: 954-239-3902
Mailing address:
  • Phone: 239-308-9028
  • Fax: 954-239-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. GUY SPERDUTO
Title or Position: MANAGER
Credential:
Phone: 239-308-9028