# GULF COAST ALLERGY CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588779482
- **Authorized official:** DR. USHA CHANDRAHASA M.D. (PHYSICIAN)
- **Authorized official phone:** (941) 743-2277

## Contact information

- **Practice address:** 3400 TAMIAMI TRL, SUITE 201, PORT CHARLOTTE, FL 33952-8102
- **Practice address phone:** (941) 743-2277
- **Practice address fax:** (941) 743-2275
- **Mailing address:** PO BOX 494507, PORT CHARLOTTE, FL 33949-4507
- **Mailing address phone:** (941) 743-2277
- **Mailing address fax:** (941) 743-2275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | ME84695 | FL | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 10/22/2007