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NPI Code Detail

MEDICARE: NEUROBEHAVIORAL MEDICINE LLC

MEDICARE: NEUROBEHAVIORAL MEDICINE LLC
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1780130773
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROBEHAVIORAL MEDICINE LLC
Provider Business Mailing Address
First Line : PO BOX 271894
Second Line :
City : TAMPA
State : FL
Zip : 33688-1894
Country : US
Telephone Number : 215-863-1653
Fax Number :
Provider Business Practice Location Address
First Line : 613 W DR MARTIN LUTHER KING JR BLVD STE 104
Second Line :
City : TAMPA
State : FL
Zip : 33603-3400
Country : US
Telephone Number : 813-587-9911
Fax Number : 833-905-0111
Authorized Official
Title or Position : OWNER
Name : PRAGNESH P PATEL
Credential : MD
Telephone Number : 215-863-1653
Provider Enumeration Date : 08/30/2016
Last Update Date : 02/19/2024

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Directions to “NEUROBEHAVIORAL MEDICINE LLC ” Practice Location

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