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General NPI Number Information
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NPI Number | 1225300833
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Entity Type | Organization
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Legal Business Name | CENTER FOR NEUROPSYCHIATRY PLLC
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 8225 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-3016
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Country | US
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Telephone | 309-310-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-3016
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Country | US
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Telephone | 309-310-4399
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/MEMBER
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Name | GNANESWARA V MIDATHALA
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Credential | M.D.
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Telephone | 309-310-4399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME109325
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License Number State | FL
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