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General NPI Number Information
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NPI Number | 1972039584
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Entity Type | Organization
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Legal Business Name | GULF COAST NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 2650 BAHIA VISTA ST SUITE 201
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City | SARASOTA
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State | FL
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Zip | 34239-2635
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Country | US
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Telephone | 941-993-3074
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Fax | 941-722-3039
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Provider Business Mailing Address
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Address Line | 2650 BAHIA VISTA ST SUITE 201
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City | SARASOTA
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State | FL
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Zip | 34239-2635
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Country | US
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Telephone | 941-993-3074
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Fax | 941-722-3039
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAUN KELLEY O'NEAL
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Credential | PSYD
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Telephone | 941-993-3074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY7351
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License Number State | FL
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