Healthcare Provider Details

I. General information

NPI: 1528898905
Provider Name (Legal Business Name): P&O PEDIATRIC AND FETAL CARDIOLOGY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 SW GLENVIEW CT SUITES 812, 814, 818
PORT ST LUCIE FL
34953-2684
US

IV. Provider business mailing address

991 STINSON WAY STE 401
WEST PALM BEACH FL
33411-3739
US

V. Phone/Fax

Practice location:
  • Phone: 772-530-2942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL LEWIS
Title or Position: OWNER / MD
Credential:
Phone: 772-530-2942