Provider Demographics
NPI:1225132251
Name:MEDALIE, NEIL STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:STANLEY
Last Name:MEDALIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 36TH ST
Mailing Address - Street 2:BLD A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3790 7TH TER
Practice Address - Street 2:SUITE #102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6552
Practice Address - Country:US
Practice Address - Phone:772-567-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 83624207ZD0900X, 207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology