Healthcare Provider Details

I. General information

NPI: 1548270101
Provider Name (Legal Business Name): DESIGN NEUROSCIENCE CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 NW 77TH CT STE 306
MIAMI LAKES FL
33016-1592
US

IV. Provider business mailing address

14400 NW 77TH CT STE 306
MIAMI LAKES FL
33016-1592
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax: 305-653-5513
Mailing address:
  • Phone: 305-653-5155
  • Fax: 305-653-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberOS4730
License Number StateFL

VIII. Authorized Official

Name: DR. KESTER J. NEDD
Title or Position: PRESIDENT
Credential: D.O.
Phone: 305-653-5155