Healthcare Provider Details

I. General information

NPI: 1659292449
Provider Name (Legal Business Name): EARLY SPECTRUM ID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 W SWANN AVE STE 201
TAMPA FL
33609-4050
US

IV. Provider business mailing address

2919 W SWANN AVE STE 201
TAMPA FL
33609-4050
US

V. Phone/Fax

Practice location:
  • Phone: 682-225-3056
  • Fax:
Mailing address:
  • Phone: 682-225-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAMAR INGULLI
Title or Position: CEO
Credential: PSY.D.
Phone: 682-225-3056