=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033758040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE NEUROPSYCHOLOGY OF INDIANA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2019
-----------------------------------------------------
Last Update Date | 03/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10293 N MERIDIAN ST STE 210
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46290-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-581-2292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10293 N MERIDIAN ST STE 210
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46290-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROPSYCHOLOGIST
-----------------------------------------------------
Name | DR. AYCA BYERLEY
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 317-581-2922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------