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General NPI Number Information
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NPI Number | 1477539807
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROLOGY CENTER
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Dates
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Enumeration Date | 12/18/2005
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 5133 SOUTH LAKELAND DRIVE
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City | LAKELAND
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State | FL
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Zip | 33813
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Country | US
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Telephone | 888-362-2343
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Fax | 888-388-1340
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Provider Business Mailing Address
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Address Line | 5133 SOUTH LAKELAND DRIVE
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City | LAKELAND
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State | FL
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Zip | 33813
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Country | US
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Telephone | 888-362-2343
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Fax | 888-388-1340
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUSARRAT N QURESHI
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Credential | M.D.
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Telephone | 888-362-2343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | ME 87941
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License Number State | FL
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