Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301077626 | MI |
Y | 207K00000X | Allergist & Immunologist | ME 114793 | FL |
N | 207KA0200X | Allergist | ME114793 | FL |
N | 2080P0201X | Pediatric Allergist | ME114793 | FL |
NPI | 1578538476 |
---|---|
Provider Name | Dr. Ami Degala |
First Address | Palm Harbor, FL 34683-3811 |
Second Address | Palm Harbor, FL 34684-2648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 10/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HQ0502 | (02) | FL |