Healthcare Provider Details

I. General information

NPI: 1497691919
Provider Name (Legal Business Name): NUR BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E BLOOMINGDALE AVE
BRANDON FL
33511-8155
US

IV. Provider business mailing address

1112 LAKE HIGHVIEW LN
BRANDON FL
33510-2142
US

V. Phone/Fax

Practice location:
  • Phone: 656-222-0703
  • Fax:
Mailing address:
  • Phone: 656-222-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CORY MOHAMMED
Title or Position: MANAGER
Credential:
Phone: 656-222-0703