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General NPI Number Information
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NPI Number | 1942363395
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Entity Type | Organization
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Legal Business Name | SPACE COAST NEUROLOGY AND PAIN MANAGEMENT PA
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 4951 BABCOCK ST NE SUITE 1
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City | PALM BAY
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State | FL
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Zip | 32905-2821
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Country | US
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Telephone | 321-984-7997
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Fax | 321-984-7935
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Provider Business Mailing Address
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Address Line | 4951 BABCOCK ST NE SUITE 1
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City | PALM BAY
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State | FL
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Zip | 32905-2821
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Country | US
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Telephone | 321-984-7997
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Fax | 321-984-7935
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Authorized Official
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Title or Position | OWNER
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Name | MASOOD HASHMI
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Credential | MD
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Telephone | 321-984-7997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ARNP 9203833
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0072245
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License Number State | FL
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