Healthcare Provider Details

I. General information

NPI: 1881158921
Provider Name (Legal Business Name): JARED A NEUBRANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

IV. Provider business mailing address

125 NEPTUNE DR
HYPOLUXO FL
33462-6019
US

V. Phone/Fax

Practice location:
  • Phone: 561-504-2305
  • Fax: 954-856-2904
Mailing address:
  • Phone: 561-504-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: