MEDICARE: BROWARD INSTITUTE OF NEURO SCIENCE L L C

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	103TP0016X	Prescribing (Medical) Psychologist	BE8849854	FL
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1245429463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD INSTITUTE OF NEURO SCIENCE L L C

Provider Business Mailing Address
First Line	:	7501 WILES RD STE 105
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2063
Country	:	US
Telephone Number	:	954-341-1022
Fax Number	:	954-341-1082

Provider Business Practice Location Address
First Line	:	7501 WILES RD STE 105
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2063
Country	:	US
Telephone Number	:	954-341-1022
Fax Number	:	954-341-1082

Authorized Official
Title or Position	:	CLINICAL DIRECTOR/CHAIRMAN
Name	:	RICARDO K ESPAILLAT
Credential	:	MD
Telephone Number	:	954-341-1022

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	11/05/2021

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