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General NPI Number Information
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NPI Number | 1881942779
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 801 W BAY DR STE 605
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City | LARGO
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State | FL
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Zip | 33770-3268
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Country | US
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Telephone | 727-489-3305
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Fax | 727-499-9559
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Provider Business Mailing Address
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Address Line | 801 W BAY DR STE 605
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City | LARGO
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State | FL
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Zip | 33770-3268
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Country | US
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Telephone | 727-489-3305
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Fax | 727-499-9559
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SUNIT SRIVASTAVA
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Credential | M.D.
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Telephone | 727-644-1540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME105069
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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