# MANUEL GALLEGO MD PA

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

## Provider details

- **NPI number:** 1821213323
- **Authorized official:** PROF. LYNNE PARKER GALLEGO MBA (ADMINISTRATOR)
- **Authorized official phone:** (941) 764-6300

## Contact information

- **Practice address:** 3466 DEPEW AVE, PORT CHARLOTTE, FL 33952-7015
- **Practice address phone:** (941) 764-6300
- **Practice address fax:** (941) 764-7297
- **Mailing address:** PO BOX 510298, PUNTA GORDA, FL 33951-0298
- **Mailing address phone:** (041) 764-6300
- **Mailing address fax:** (941) 764-7297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC1900X | Counseling Psychologist | MH0004146 | FL | Yes |
| 2084P0800X | Psychiatry Physician | ME0076119 | FL | — |

## Other

- **Enumeration date:** 04/17/2007
- **Last updated:** 09/11/2025