Provider Demographics
NPI:1467206524
Name:PEDIATRIC NEUROCARE INSTITUTE LLC
Entity Type:Organization
Organization Name:PEDIATRIC NEUROCARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROLOGIST/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HIMALI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYAKODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-652-2110
Mailing Address - Street 1:4030 HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-4940
Mailing Address - Country:US
Mailing Address - Phone:480-652-2110
Mailing Address - Fax:
Practice Address - Street 1:170 PINE AVE N
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4629
Practice Address - Country:US
Practice Address - Phone:480-652-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty