Healthcare Provider Details

I. General information

NPI: 1932013034
Provider Name (Legal Business Name): JUSTIN SCHLAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 KNIGHT DR
TARPON SPRINGS FL
34688-7271
US

IV. Provider business mailing address

410 KNIGHT DR
TARPON SPRINGS FL
34688-7271
US

V. Phone/Fax

Practice location:
  • Phone: 727-420-3107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number162870
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number162870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: