MEDICARE: S A NEUROLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME71135	FL

General Provider Information

NPI Number	:	1023089067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S A NEUROLOGY LLC

Provider Business Mailing Address
First Line	:	11336 BRIDGE HOUSE RD
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-5405
Country	:	US
Telephone Number	:	407-876-8243
Fax Number	:	407-909-1187

Provider Business Practice Location Address
First Line	:	7376 STONEROCK CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8000
Country	:	US
Telephone Number	:	407-226-9766
Fax Number	:	407-226-9834

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AZRA ULLAH
Credential	:
Telephone Number	:	407-226-9766

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	12/04/2013

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