Healthcare Provider Details

I. General information

NPI: 1386105211
Provider Name (Legal Business Name): OLESYA PALKO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WHITAKER RD STE B
LUTZ FL
33549-5792
US

IV. Provider business mailing address

7901 4TH ST N STE 14526
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 813-461-5445
  • Fax: 813-607-4094
Mailing address:
  • Phone: 813-461-5445
  • Fax: 813-607-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4327
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: