MEDICARE: UCED PLLC

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	2084N0600X	Clinical Neurophysiology Physician	ME 106875	FL
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME 106875	FL

General Provider Information

NPI Number	:	1144663162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCED PLLC

Provider Business Mailing Address
First Line	:	PO BOX 490950
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-0950
Country	:	US
Telephone Number	:	973-204-4727
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S LAKE ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5920
Country	:	US
Telephone Number	:	973-204-4727
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARTHUR E NWAUBANI
Credential	:	MD
Telephone Number	:	973-204-4727

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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