Healthcare Provider Details

I. General information

NPI: 1578538476
Provider Name (Legal Business Name): AMI K DEGALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33920 US HIGHWAY 19N SUITE 341
PALM HARBOR FL
34684
US

IV. Provider business mailing address

33920 US HIGHWAY 19N SUITE 341
PALM HARBOR FL
34684
US

V. Phone/Fax

Practice location:
  • Phone: 727-787-6744
  • Fax: 727-786-3561
Mailing address:
  • Phone: 727-787-6744
  • Fax: 727-786-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301077626
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME 114793
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME114793
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME114793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: