Healthcare Provider Details

I. General information

NPI: 1972838498
Provider Name (Legal Business Name): NEUROLOGY ASSOCIATES OF SUFFOLK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 HARBOUR VIEW BLVD STE 201
SUFFOLK VA
23435-3797
US

IV. Provider business mailing address

150 BURNETTS WAY SUITE 320
SUFFOLK VA
23434-8168
US

V. Phone/Fax

Practice location:
  • Phone: 757-967-0406
  • Fax: 757-967-0675
Mailing address:
  • Phone: 757-934-1900
  • Fax: 757-925-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HOLLAND GOLDEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-967-0406