Healthcare Provider Details

I. General information

NPI: 1154568145
Provider Name (Legal Business Name): FLORIDA CENTER FOR NEUROLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 DR MARTIN LUTHER KING ST N
ST PETERSBURG FL
33704-4226
US

IV. Provider business mailing address

1607 DR MARTIN LUTHER KING ST N
ST PETERSBURG FL
33704-4226
US

V. Phone/Fax

Practice location:
  • Phone: 727-329-8833
  • Fax: 727-329-8840
Mailing address:
  • Phone: 727-329-8833
  • Fax: 727-329-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberME67462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME67462
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME67462
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberME67462
License Number StateFL

VIII. Authorized Official

Name: DR. ERASMO ANDRE PASSARO
Title or Position: PRESIDENT
Credential: MD
Phone: 727-329-8833