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Organization
MARY M PELLEGRINO
Active
Organization
MARY M PELLEGRINO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PELLEGRINO (OWNER)
(850) 878-0609
Entity
Organization
Contact information
Practice address
3215 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL 32308-4413
(850) 878-0609
Mailing address
3215 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL 32308-4413
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA2251
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
880934800
—
FL
Enumeration date
05/02/2006
Last updated
04/12/2012
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