Provider Demographics
NPI:1639608516
Name:UNIVERSITY NEURO, LLC
Entity Type:Organization
Organization Name:UNIVERSITY NEURO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-380-3305
Mailing Address - Street 1:DEPT 880256 PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:609-380-3305
Mailing Address - Fax:609-521-4092
Practice Address - Street 1:925B PEACHTREE ST NE STE 710
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3918
Practice Address - Country:US
Practice Address - Phone:609-380-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty