Healthcare Provider Details

I. General information

NPI: 1336604149
Provider Name (Legal Business Name): FLORIDA NEUROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ASHLEY DR STE 600-101
TAMPA FL
33602-5304
US

IV. Provider business mailing address

100 S ASHLEY DR STE 600-101
TAMPA FL
33602-5304
US

V. Phone/Fax

Practice location:
  • Phone: 609-380-3305
  • Fax:
Mailing address:
  • Phone: 609-380-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DOREEN SHINN
Title or Position: CFO
Credential:
Phone: 609-380-3305