Healthcare Provider Details

I. General information

NPI: 1093624330
Provider Name (Legal Business Name): GALLOWAY VELASQUEZ FULL BARBER/COSMETOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 BRADDOCK DR
ZEPHYRHILLS FL
33541-9626
US

IV. Provider business mailing address

PO BOX 304
ZEPHYRHILLS FL
33539-0304
US

V. Phone/Fax

Practice location:
  • Phone: 813-900-0532
  • Fax:
Mailing address:
  • Phone: 813-900-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: