Healthcare Provider Details

I. General information

NPI: 1457358434
Provider Name (Legal Business Name): COASTAL NEUROLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W GRANADA BLVD SUITE 22
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

725 W GRANADA BLVD SUITE 22
ORMOND BEACH FL
32174
US

V. Phone/Fax

Practice location:
  • Phone: 386-788-2300
  • Fax: 386-944-6622
Mailing address:
  • Phone: 386-788-2300
  • Fax: 386-944-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS5774
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME84820
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1823
License Number StateFL

VIII. Authorized Official

Name: DR. NEIL M BROWN
Title or Position: CEO
Credential: D.C.
Phone: 386-788-2300