Provider Demographics
NPI:1962774018
Name:ALLERGY SPECIALISTS OF PALM BEACHES
Entity type:Organization
Organization Name:ALLERGY SPECIALISTS OF PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANUJA
Authorized Official - Middle Name:TIRUNAGARI
Authorized Official - Last Name:VEDERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-335-7888
Mailing Address - Street 1:PO BOX 30425
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-0425
Mailing Address - Country:US
Mailing Address - Phone:772-335-7888
Mailing Address - Fax:772-335-0331
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:C107
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-335-7888
Practice Address - Fax:772-335-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76026207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255468203Medicaid
43935Medicare PIN
FL255468203Medicaid