Healthcare Provider Details

I. General information

NPI: 1255878849
Provider Name (Legal Business Name): FRONTIERMED ALLERGY AND ASTHMA CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 TOWN CENTER DR
ORANGE CITY FL
32763-8361
US

IV. Provider business mailing address

150 RIDGEWAY DR
BRIDGEPORT WV
26330-1175
US

V. Phone/Fax

Practice location:
  • Phone: 386-366-5530
  • Fax: 855-936-1288
Mailing address:
  • Phone: 304-406-6402
  • Fax: 855-936-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number21119
License Number StateWV

VIII. Authorized Official

Name: SALLY DEE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 304-406-6402