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
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
ME105069
FL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME105069
MEDICAL LICENSE NUMBER
FL
Enumeration date
08/27/2012
Last updated
09/26/2025
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