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General NPI Number Information
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NPI Number | 1659740173
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Entity Type | Organization
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Legal Business Name | HOME CARE NEUROLOGY
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 630 SHERRY DR
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-5356
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Country | US
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Telephone | 912-308-5113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331027
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-1027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON SEBESTO
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Credential | DO
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Telephone | 912-308-5113
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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 | OS11900
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License Number State | FL
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