Healthcare Provider Details

I. General information

NPI: 1982198222
Provider Name (Legal Business Name): NDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 SW MARTIN DOWNS BLVD SUITE 202
PALM CITY FL
34990
US

IV. Provider business mailing address

1497 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2802
US

V. Phone/Fax

Practice location:
  • Phone: 772-337-8500
  • Fax: 772-337-8505
Mailing address:
  • Phone: 772-337-8500
  • Fax: 772-337-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE TOLEDO
Title or Position: OWNER
Credential: MD
Phone: 772-337-8500