Healthcare Provider Details

I. General information

NPI: 1477854057
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 CYPRESS RIDGE BLVD SUITE A
WESLEY CHAPEL FL
33544-6312
US

IV. Provider business mailing address

405 S SHORE CREST DR
TAMPA FL
33609-3625
US

V. Phone/Fax

Practice location:
  • Phone: 813-388-6855
  • Fax: 813-364-8107
Mailing address:
  • Phone: 813-388-6855
  • Fax: 813-364-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMRIDHI NARULA NALLAMSHETTY
Title or Position: OWNER AND PROVIDER
Credential: MD
Phone: 813-388-6855