Healthcare Provider Details

I. General information

NPI: 1669723029
Provider Name (Legal Business Name): LEENA CHACKO SALINE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LEENA CHACKO

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD STE 200
LUTZ FL
33558-8005
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-6490
  • Fax: 813-443-8143
Mailing address:
  • Phone: 727-281-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS15786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: