MEDICARE: COASTAL NEUROLOGICAL INSTITUE OF FLORIDA

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1609231216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL NEUROLOGICAL INSTITUE OF FLORIDA

Provider Business Mailing Address
First Line	:	200 2ND AVE S # 474
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-4313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 2ND AVE S # 474
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-4313
Country	:	US
Telephone Number	:	727-465-4719
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARL TYLER SHENKMAN
Credential	:	MD
Telephone Number	:	727-465-4719

Provider Enumeration Date	:	12/24/2015
Last Update Date	:	12/24/2015

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