Provider Demographics
NPI:1033313903
Name:VOLUSIA NEUROPSYCHOLOGY & BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:VOLUSIA NEUROPSYCHOLOGY & BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:SUNDVALL
Authorized Official - Last Name:MERILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:386-423-0442
Mailing Address - Street 1:221 N CAUSEWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5298
Mailing Address - Country:US
Mailing Address - Phone:386-423-0442
Mailing Address - Fax:386-423-0402
Practice Address - Street 1:221 N CAUSEWAY
Practice Address - Street 2:SUITE B
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5298
Practice Address - Country:US
Practice Address - Phone:386-423-0442
Practice Address - Fax:386-423-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6889103G00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5600Medicare ID - Type UnspecifiedGROUP NUMBER