Healthcare Provider Details

I. General information

NPI: 1023089067
Provider Name (Legal Business Name): S A NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 STONEROCK CIR
ORLANDO FL
32819-8000
US

IV. Provider business mailing address

11336 BRIDGE HOUSE RD
WINDERMERE FL
34786-5405
US

V. Phone/Fax

Practice location:
  • Phone: 407-226-9766
  • Fax: 407-226-9834
Mailing address:
  • Phone: 407-876-8243
  • Fax: 407-909-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME71135
License Number StateFL

VIII. Authorized Official

Name: AZRA ULLAH
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-226-9766