MEDICARE: PENNY W. GALLOWAY

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	101YM0800X	Mental Health Counselor	IMH28855	FL

General Provider Information

NPI Number	:	1639015894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY W. GALLOWAY

Provider Business Mailing Address
First Line	:	2195 SAN FILIPPO DR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-7206
Country	:	US
Telephone Number	:	321-616-0809
Fax Number	:	321-616-0809

Provider Business Practice Location Address
First Line	:	2195 SAN FILIPPO DR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-7206
Country	:	US
Telephone Number	:	321-616-0809
Fax Number	:	321-616-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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