Healthcare Provider Details

I. General information

NPI: 1295937373
Provider Name (Legal Business Name): NEUROLOGIC ASSOCIATES OF CENTRAL BREVARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 N COURTENAY PKWY SUITE #106
MERRITT ISLAND FL
32953-4400
US

IV. Provider business mailing address

1395 N COURTENAY PKWY SUITE #106
MERRITT ISLAND FL
32953-4400
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-1224
  • Fax: 321-453-7784
Mailing address:
  • Phone: 321-452-1224
  • Fax: 321-453-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA VALLUZZI
Title or Position: OFFICE MANAGER
Credential:
Phone: 321-452-1224