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General NPI Number Information
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NPI Number | 1699691097
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Entity Type | Organization
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Legal Business Name | OVIEDO NEUROLOGY LLC
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 1410 W BROADWAY ST STE 104
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City | OVIEDO
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State | FL
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Zip | 32765-6537
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Country | US
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Telephone | 407-447-7181
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Fax | 407-447-7184
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Provider Business Mailing Address
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Address Line | 1410 W BROADWAY ST STE 104
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City | OVIEDO
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State | FL
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Zip | 32765-6537
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Country | US
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Telephone | 407-447-7181
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Fax | 407-447-7184
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Authorized Official
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Title or Position | OWNER
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Name | MR. SHASANKA THUMU
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Credential | OWNER
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Telephone | 407-447-7181
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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 |
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License Number State |
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