Provider Demographics
NPI:1922256494
Name:GALLO, TARYN NOELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TARYN
Middle Name:NOELLE
Last Name:GALLO
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:PO BOX 405791
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5791
Mailing Address - Country:US
Mailing Address - Phone:772-589-6400
Mailing Address - Fax:772-589-6441
Practice Address - Street 1:14430 US HIGHWAY 1
Practice Address - Street 2:SUITE 104
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3289
Practice Address - Country:US
Practice Address - Phone:772-589-6400
Practice Address - Fax:772-589-6441
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFJ194ZOtherMEDICARE PTAN
FL14FJ7OtherBCBS-FL PROVIDER NUMBER