MEDICARE: NEURO ESSENCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1528930013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO ESSENCE, LLC

Provider Business Mailing Address
First Line	:	4472 MAYBELLE TRL
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-3332
Country	:	US
Telephone Number	:	203-525-0674
Fax Number	:

Provider Business Practice Location Address
First Line	:	4472 MAYBELLE TRL
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-3332
Country	:	US
Telephone Number	:	203-525-0674
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHEANNA LONG
Credential	:
Telephone Number	:	203-525-0674

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	03/20/2026

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