Provider Demographics
NPI:1134999089
Name:PALM BEACH ALLERGY AND IMMUNOLOGY LLC
Entity type:Organization
Organization Name:PALM BEACH ALLERGY AND IMMUNOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-313-9014
Mailing Address - Street 1:6671 W INDIANTOWN RD STE 50-247
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3015
Practice Address - Country:US
Practice Address - Phone:561-974-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty