Healthcare Provider Details

I. General information

NPI: 1437557048
Provider Name (Legal Business Name): CENTRAL FLORIDA NEUROLOGY & SLEEP MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 COUNTRY LANDING BLVD
APOPKA FL
32703-5020
US

IV. Provider business mailing address

230 COUNTRY LANDING BLVD
APOPKA FL
32703-5020
US

V. Phone/Fax

Practice location:
  • Phone: 407-300-1188
  • Fax: 407-530-0162
Mailing address:
  • Phone: 407-300-1188
  • Fax: 407-530-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MERRITT
Title or Position: MANAGING MEMBER
Credential:
Phone: 407-300-1188