MEDICARE: CUSTOM DEZIGNS LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1215802723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSTOM DEZIGNS LLC

Provider Business Mailing Address
First Line	:	5036 DR MARTIN LUTHER KING JR ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4929
Country	:	US
Telephone Number	:	727-564-7786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 22ND ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-2254
Country	:	US
Telephone Number	:	727-564-7786
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TIFFANY COHEN
Credential	:
Telephone Number	:	726-564-7786

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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