Healthcare Provider Details

I. General information

NPI: 1578348934
Provider Name (Legal Business Name): PEDIATRIC NEUROLOGY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7951 KATY FWY STE E
HOUSTON TX
77024-1948
US

IV. Provider business mailing address

7951 KATY FWY STE E
HOUSTON TX
77024-1948
US

V. Phone/Fax

Practice location:
  • Phone: 617-458-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE E NWOSU
Title or Position: CEO / OWNER
Credential: MD
Phone: 617-458-1100