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General NPI Number Information
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NPI Number | 1639608516
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Entity Type | Organization
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Legal Business Name | UNIVERSITY NEURO, LLC
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 925B PEACHTREE ST NE STE 710
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City | ATLANTA
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State | GA
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Zip | 30309-3918
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Country | US
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Telephone | 609-380-3305
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT 880256 PO BOX 29650
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City | PHOENIX
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State | AZ
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Zip | 85038-9650
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Country | US
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Telephone | 609-380-3305
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Fax | 609-521-4092
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Authorized Official
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Title or Position | VP & CFO
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Name | DOREEN SHINN
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Credential |
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Telephone | 609-380-3305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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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 | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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