Provider Demographics
NPI:1104365550
Name:NEURO-STAT
Entity Type:Organization
Organization Name:NEURO-STAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SHENKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-330-6038
Mailing Address - Street 1:501 S LINCOLN AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5964
Mailing Address - Country:US
Mailing Address - Phone:727-357-7828
Mailing Address - Fax:727-337-7646
Practice Address - Street 1:501 S LINCOLN AVE STE 22
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5964
Practice Address - Country:US
Practice Address - Phone:727-357-7828
Practice Address - Fax:727-337-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty