Healthcare Provider Details

I. General information

NPI: 1427227701
Provider Name (Legal Business Name): COASTAL NEUROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 03/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 DOCTORS CIR
WILMINGTON NC
28401-7404
US

IV. Provider business mailing address

PO BOX 3518
WILMINGTON NC
28406-0518
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-9914
  • Fax: 910-254-9953
Mailing address:
  • Phone: 910-254-9914
  • Fax: 910-254-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number34183
License Number StateNC

VIII. Authorized Official

Name: DR. SANDRA SUSAN TORRES
Title or Position: OWNER
Credential: MD
Phone: 910-254-9914