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General NPI Number Information
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NPI Number | 1962774018
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Entity Type | Organization
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Legal Business Name | ALLERGY SPECIALISTS OF PALM BEACHES
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DR C107
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7553
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Country | US
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Telephone | 772-335-7888
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Fax | 772-335-0331
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Provider Business Mailing Address
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Address Line | PO BOX 30425
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33420-0425
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Country | US
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Telephone | 772-335-7888
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Fax | 772-335-0331
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. TANUJA TIRUNAGARI VEDERE
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Credential | MD
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Telephone | 772-335-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | ME76026
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License Number State | FL
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