=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457070526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEURO HEALTH & WELLNESS CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2022
-----------------------------------------------------
Last Update Date | 08/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 HARBOR BLVD STE 305
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-5344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-500-4638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 HARBOR BLVD STE 305
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-5344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-500-4638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO-PRESIDENT
-----------------------------------------------------
Name | HARPREET GREWAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 941-500-4638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------