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General NPI Number Information
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NPI Number | 1578922613
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Entity Type | Organization
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Legal Business Name | LAKE CITY INSTITUTE OF NEUROLOGY PA
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 4745 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1400
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Country | US
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Telephone | 407-818-1664
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Fax | 407-818-1654
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Provider Business Mailing Address
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Address Line | 4745 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1400
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Country | US
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Telephone | 407-818-1664
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Fax | 407-818-1654
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. REKHA NIDADAVOLU
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Credential |
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Telephone | 305-905-9316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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