Healthcare Provider Details

I. General information

NPI: 1073007076
Provider Name (Legal Business Name): JUSTIN SHAWN PILIEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-5779
US

IV. Provider business mailing address

500 KNIGHTS RUN AVE UNIT 1408
TAMPA FL
33602-6015
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone: 813-410-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: