Provider Demographics
NPI:1578538476
Name:DEGALA, AMI K (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMI
Middle Name:K
Last Name:DEGALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33920 US HIGHWAY 19N SUITE 341
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-787-6744
Mailing Address - Fax:727-786-3561
Practice Address - Street 1:33920 US HIGHWAY 19N SUITE 341
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-787-6744
Practice Address - Fax:727-786-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077626207K00000X
FLME 114793207K00000X
FLME1147932080P0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104605600Medicaid
FLHQ0502Medicare UPIN