Healthcare Provider Details

I. General information

NPI: 1235911298
Provider Name (Legal Business Name): NEWROLOGIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4063 N GOLDENROD RD # 101
WINTER PARK FL
32792-8914
US

IV. Provider business mailing address

720 MILLSHORE DR
CHULUOTA FL
32766-9307
US

V. Phone/Fax

Practice location:
  • Phone: 407-963-6400
  • Fax:
Mailing address:
  • Phone: 407-963-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN QUEVEDO
Title or Position: OWNER
Credential: MS
Phone: 407-963-6400