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General NPI Number Information
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NPI Number | 1225949365
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Entity Type | Organization
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Legal Business Name | LEGACY WHOLE HEALTH, PLLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 3212 COVE BEND DR
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City | TAMPA
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State | FL
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Zip | 33613-2752
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Country | US
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Telephone | 813-945-9821
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Fax | 813-742-5412
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Provider Business Mailing Address
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Address Line | 3212 COVE BEND DR
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City | TAMPA
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State | FL
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Zip | 33613-2752
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Country | US
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Telephone | 813-945-9821
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Fax | 813-742-5412
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANIA AYANNA DEJESUS
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Credential | DO
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Telephone | 646-662-7578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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