MEDICARE: TRANSFORMATIONAL LIFE CONSULTING MEDICAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1053286823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIONAL LIFE CONSULTING MEDICAL PLLC

Provider Business Mailing Address
First Line	:	1400 VILLAGE SQUARE BLVD # 3-85340
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	850-296-5091
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 E ELEANA LN
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-5776
Country	:	US
Telephone Number	:	850-296-5091
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DEEPA GRANDON
Credential	:	MD
Telephone Number	:	850-296-5091

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

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