MEDICARE: HOME CARE NEUROLOGY

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	OS11900	FL

General Provider Information

NPI Number	:	1659740173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE NEUROLOGY

Provider Business Mailing Address
First Line	:	PO BOX 331027
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-1027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 SHERRY DR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5356
Country	:	US
Telephone Number	:	912-308-5113
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON SEBESTO
Credential	:	DO
Telephone Number	:	912-308-5113

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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