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General NPI Number Information
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NPI Number | 1255460747
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Entity Type | Organization
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Legal Business Name | PEDINET, LLC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34 HERITAGE POINT DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3245
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Country | US
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Telephone | 864-704-5534
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Fax |
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Provider Business Mailing Address
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Address Line | 34 HERITAGE POINT DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MINDO J NATALE
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Credential | PSYD
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Telephone | 864-704-5534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1020
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License Number State | SC
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