Provider Demographics
NPI:1073646147
Name:NEUROPSYCHOLOGICAL INSTITUE, P.A.
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL INSTITUE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRESHWATER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-632-9902
Mailing Address - Street 1:801 BRICKELL AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2951
Mailing Address - Country:US
Mailing Address - Phone:305-632-9902
Mailing Address - Fax:305-371-4447
Practice Address - Street 1:801 BRICKELL AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2951
Practice Address - Country:US
Practice Address - Phone:305-632-9902
Practice Address - Fax:305-371-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6446103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4189Medicare ID - Type UnspecifiedGROUP PRACTICE