Provider Demographics
NPI:1508287715
Name:TITUSVILLE NEUROLOGY LLC
Entity Type:Organization
Organization Name:TITUSVILLE NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PATALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-383-0900
Mailing Address - Street 1:123 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3377
Mailing Address - Country:US
Mailing Address - Phone:321-383-0900
Mailing Address - Fax:321-383-0024
Practice Address - Street 1:123 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3377
Practice Address - Country:US
Practice Address - Phone:321-383-0900
Practice Address - Fax:321-383-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13868OtherBLUE CROSS BLUE SHIELD
FLH68049Medicare UPIN