Healthcare Provider Details

I. General information

NPI: 1114624277
Provider Name (Legal Business Name): PONTE VEDRA NEUROPSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EXECUTIVE WAY STE 212
PONTE VEDRA BEACH FL
32082-2714
US

IV. Provider business mailing address

176 PARKBLUFF CIR
PONTE VEDRA FL
32081-0958
US

V. Phone/Fax

Practice location:
  • Phone: 904-709-4542
  • Fax:
Mailing address:
  • Phone: 904-303-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KARI ENG
Title or Position: NEUROPSYCHOLOGIST / OWNER
Credential:
Phone: 904-303-8362