MEDICARE: NEURODIVERGENT EMPOWERMENT INSTITUE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084P0015X	Psychosomatic Medicine Physician
2	363LP2300X	Primary Care Nurse Practitioner
3	163WC0400X	Case Management Registered Nurse
4	207R00000X	Internal Medicine Physician
5	101YM0800X	Mental Health Counselor
6	103TB0200X	Cognitive & Behavioral Psychologist
7	102X00000X	Poetry Therapist
8	225A00000X	Music Therapist
9	163WM0705X	Medical-Surgical Registered Nurse
10	207Q00000X	Family Medicine Physician
11	103TH0004X	Health Psychologist
12	101200000X	Drama Therapist
13	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1578385092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURODIVERGENT EMPOWERMENT INSTITUE INC

Provider Business Mailing Address
First Line	:	2232 2ND AVE S UNIT 134
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1210
Country	:	US
Telephone Number	:	727-490-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 2ND AVE S UNIT 134
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1210
Country	:	US
Telephone Number	:	727-490-9911
Fax Number	:

Authorized Official
Title or Position	:	CFEO
Name	:	ANGELA L FISHER
Credential	:
Telephone Number	:	720-791-7324

Provider Enumeration Date	:	10/26/2024
Last Update Date	:	03/22/2026

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