Provider Demographics
NPI:1275568859
Name:PEDIATRIC NEUROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC NEUROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CASADONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-498-8994
Mailing Address - Street 1:625 6TH AVE S
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4662
Mailing Address - Country:US
Mailing Address - Phone:727-498-8994
Mailing Address - Fax:727-498-8982
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:SUITE 405
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:727-498-8994
Practice Address - Fax:727-498-8982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PEDIATRICS ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty