Healthcare Provider Details

I. General information

NPI: 1518875350
Provider Name (Legal Business Name): NEUROWAY TMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 PALM BLVD S
NICEVILLE FL
32578-2603
US

IV. Provider business mailing address

132 MONAHAN DR
FORT WALTON BEACH FL
32547-3714
US

V. Phone/Fax

Practice location:
  • Phone: 850-496-8780
  • Fax: 850-496-8780
Mailing address:
  • Phone: 850-496-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES CLANCY
Title or Position: CEO
Credential: PA-C
Phone: 850-496-8780