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Organization
LEGACY HEALTH MEDICAL GROUP, LLC
Active
Organization
LEGACY HEALTH MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUNIT SRIVASTAVA M.D. (MANAGING MEMBER)
(727) 644-1540
Entity
Organization
Contact information
Practice address
801 W BAY DR STE 605, LARGO, FL 33770-3268
(727) 489-3305
(727) 499-9559
Mailing address
801 W BAY DR STE 605, LARGO, FL 33770-3268
(727) 489-3305
(727) 499-9559
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
NULL
163WW0000X
Wound Care Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
ME105069
FL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
NULL
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Enumeration date
08/27/2012
Last updated
09/26/2025
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