Provider Demographics
NPI:1225300833
Name:CENTER FOR NEUROPSYCHIATRY PLLC
Entity Type:Organization
Organization Name:CENTER FOR NEUROPSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GNANESWARA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MIDATHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-310-4399
Mailing Address - Street 1:8225 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3016
Mailing Address - Country:US
Mailing Address - Phone:309-310-4399
Mailing Address - Fax:
Practice Address - Street 1:8225 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3016
Practice Address - Country:US
Practice Address - Phone:309-310-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1093252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty