MEDICARE: NEUROSCIENCE AND SPINE ASSOCIATES PL

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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1669536645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSCIENCE AND SPINE ASSOCIATES PL

Provider Business Mailing Address
First Line	:	3451 PINE RIDGE ROAD
Second Line	:	BUILDING 601
City	:	NAPLES
State	:	FL
Zip	:	34109-3884
Country	:	US
Telephone Number	:	239-449-7900
Fax Number	:	239-449-7959

Provider Business Practice Location Address
First Line	:	130 TAMIAMI TRL N STE 250
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6233
Country	:	US
Telephone Number	:	239-263-1641
Fax Number	:	239-649-7473

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING
Name	:	CHERYL ANN LEACH
Credential	:
Telephone Number	:	239-449-3072

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	02/15/2024

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