MEDICARE: MR. JUSTIN M TELLO

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	111N00000X	Chiropractor	12893	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770134132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN M TELLO

Provider Business Mailing Address
First Line	:	5420 LAND O' LAKES BLVD SUITE 105
Second Line	:
City	:	LAND O' LAKES
State	:	FL
Zip	:	34639
Country	:	US
Telephone Number	:	727-365-7674
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 LAND O' LAKES BLVD SUITE 105
Second Line	:
City	:	LAND O' LAKES
State	:	FL
Zip	:	34639
Country	:	US
Telephone Number	:	813-996-9800
Fax Number	:	813-874-0471

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	12/02/2025

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Directions to “ MR. JUSTIN M TELLO ” Practice Location

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