Healthcare Provider Details

I. General information

NPI: 1003738063
Provider Name (Legal Business Name): MICHAEL JAMES PALO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E GRANADA BLVD
ORMOND BEACH FL
32176-6694
US

IV. Provider business mailing address

1617 TOWN PARK DR
PORT ORANGE FL
32129-7501
US

V. Phone/Fax

Practice location:
  • Phone: 740-233-1432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: