Healthcare Provider Details

I. General information

NPI: 1407762271
Provider Name (Legal Business Name): NEURODIAGNOSTIC ADVANCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 SW 34TH MNR STE 470
DAVIE FL
33328-1987
US

IV. Provider business mailing address

7630 SW 34TH MNR STE 470
DAVIE FL
33328-1987
US

V. Phone/Fax

Practice location:
  • Phone: 954-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA KASSA
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 904-610-4653