Healthcare Provider Details

I. General information

NPI: 1114220845
Provider Name (Legal Business Name): NEUROSCIENCE AND SPINE ASSOCIATES PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD STE 101
NAPLES FL
34119-3900
US

IV. Provider business mailing address

3451 PINE RIDGE RD BLDG 601
NAPLES FL
34109-3922
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-1662
  • Fax:
Mailing address:
  • Phone: 239-449-3072
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ANN LEACH
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 239-449-3072