Provider Demographics
NPI:1235911298
Name:NEWROLOGIX, LLC
Entity Type:Organization
Organization Name:NEWROLOGIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:407-963-6400
Mailing Address - Street 1:720 MILLSHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-9307
Mailing Address - Country:US
Mailing Address - Phone:407-963-6400
Mailing Address - Fax:
Practice Address - Street 1:4063 N GOLDENROD RD # 101
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8914
Practice Address - Country:US
Practice Address - Phone:407-963-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty