MEDICARE: CENTER FOR NEUROPSYCHIATRY 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	2084P0800X	Psychiatry Physician	ME109325	FL

General Provider Information

NPI Number	:	1225300833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR NEUROPSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	8225 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3016
Country	:	US
Telephone Number	:	309-310-4399
Fax Number	:

Provider Business Practice Location Address
First Line	:	8225 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3016
Country	:	US
Telephone Number	:	309-310-4399
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/MEMBER
Name	:	GNANESWARA V MIDATHALA
Credential	:	M.D.
Telephone Number	:	309-310-4399

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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