MEDICARE: MANUEL GALLEGO MD PA

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	2084P0800X	Psychiatry Physician	ME0076119	FL
2	103TC1900X	Counseling Psychologist	MH0004146	FL

General Provider Information

NPI Number	:	1821213323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANUEL GALLEGO MD PA

Provider Business Mailing Address
First Line	:	PO BOX 510298
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33951-0298
Country	:	US
Telephone Number	:	41-764-6300
Fax Number	:	941-764-7297

Provider Business Practice Location Address
First Line	:	3466 DEPEW AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-7015
Country	:	US
Telephone Number	:	941-764-6300
Fax Number	:	941-764-7297

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PROF. LYNNE PARKER GALLEGO
Credential	:	MBA
Telephone Number	:	941-764-6300

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	09/11/2025

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