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General NPI Number Information
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NPI Number | 1871611749
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Entity Type | Organization
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Legal Business Name | ST AUGUSTINE NEUROLOGY PA
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 208 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5135
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Country | US
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Telephone | 904-824-2201
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Fax | 904-824-2353
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Provider Business Mailing Address
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Address Line | 301 HEALTH PARK BLVD SUITE 220
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5793
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Country | US
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Telephone | 904-824-2201
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Fax | 904-824-2373
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. JUEYANG WEI
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Credential |
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Telephone | 904-824-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME97839
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License Number State | FL
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