Healthcare Provider Details

I. General information

NPI: 1427312669
Provider Name (Legal Business Name): LIUDMILA BUELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIUDMILA YUNCHENKO

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W BAY DR STE 202
LARGO FL
33770-2276
US

IV. Provider business mailing address

1345 W BAY DR STE 202
LARGO FL
33770-2276
US

V. Phone/Fax

Practice location:
  • Phone: 727-559-0895
  • Fax: 727-518-7633
Mailing address:
  • Phone: 727-559-0895
  • Fax: 727-518-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME122555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: