Healthcare Provider Details

I. General information

NPI: 1437979622
Provider Name (Legal Business Name): EL- SALAWY MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTHPARK BLVD STE 102
SAINT AUGUSTINE FL
32086-5122
US

IV. Provider business mailing address

150 SOUTHPARK BLVD STE 102
SAINT AUGUSTINE FL
32086-5122
US

V. Phone/Fax

Practice location:
  • Phone: 904-342-5002
  • Fax: 904-342-5550
Mailing address:
  • Phone: 352-514-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MITCHELL HALL
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 386-385-3857