Healthcare Provider Details

I. General information

NPI: 1740104975
Provider Name (Legal Business Name): ALL WELL PEDIATRICS GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 STATE ROAD 52
HUDSON FL
34667-6714
US

IV. Provider business mailing address

17541 N DALE MABRY HWY
LUTZ FL
33548-4521
US

V. Phone/Fax

Practice location:
  • Phone: 813-964-1800
  • Fax: 813-964-1880
Mailing address:
  • Phone: 813-964-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GOWTHAMAN PANDIAN
Title or Position: COO
Credential:
Phone: 813-816-5124