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General NPI Number Information
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NPI Number | 1235911298
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Entity Type | Organization
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Legal Business Name | NEWROLOGIX, LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 4063 N GOLDENROD RD # 101
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City | WINTER PARK
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State | FL
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Zip | 32792-8914
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Country | US
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Telephone | 407-963-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 720 MILLSHORE DR
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City | CHULUOTA
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State | FL
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Zip | 32766-9307
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Country | US
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Telephone | 407-963-6400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADRIAN QUEVEDO
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Credential | MS
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Telephone | 407-963-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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