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General NPI Number Information
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NPI Number | 1407662455
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Entity Type | Organization
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Legal Business Name | BRAINMATTERS NEUROLOGY PLLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 3391 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5231
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Country | US
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Telephone | 910-333-0026
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Fax | 800-759-6517
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Provider Business Mailing Address
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Address Line | 3391 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5231
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Country | US
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Telephone | 910-333-0026
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Fax | 800-759-6517
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SASIDHARAN TARAVATH
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Credential | MD
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Telephone | 910-833-0356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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