Healthcare Provider Details

I. General information

NPI: 1750346789
Provider Name (Legal Business Name): COASTAL NEUROLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 N. PARIS AVENUE
PORT ROYAL SC
29935-2029
US

IV. Provider business mailing address

1833 N. PARIS AVENUE
PORT ROYAL SC
29935-2029
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-1420
  • Fax: 843-522-1460
Mailing address:
  • Phone: 843-522-1420
  • Fax: 843-522-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL MAZZEO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-522-1420