Provider Demographics
NPI:1821396474
Name:NEUROBEHAVIORAL MEDICINE CENTRE OF SARASOTA, INC.
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL MEDICINE CENTRE OF SARASOTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-330-2929
Mailing Address - Street 1:8400 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2936
Mailing Address - Country:US
Mailing Address - Phone:941-330-2929
Mailing Address - Fax:941-955-4880
Practice Address - Street 1:8400 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2936
Practice Address - Country:US
Practice Address - Phone:941-330-2929
Practice Address - Fax:941-955-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104998261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104998Medicare Oscar/Certification