Provider Demographics
NPI:1013642776
Name:CELESTE BRAIN HEALTH PLLC
Entity Type:Organization
Organization Name:CELESTE BRAIN HEALTH PLLC
Other - Org Name:CELESTE NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-777-9940
Mailing Address - Street 1:5500 EXECUTIVE CENTER DR STE 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8864
Mailing Address - Country:US
Mailing Address - Phone:984-777-9940
Mailing Address - Fax:877-794-5929
Practice Address - Street 1:5500 EXECUTIVE CENTER DR STE 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8864
Practice Address - Country:US
Practice Address - Phone:984-777-9940
Practice Address - Fax:877-794-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty