Provider Demographics
NPI:1336858232
Name:NEUROGLEE CARE PLLC
Entity Type:Organization
Organization Name:NEUROGLEE CARE PLLC
Other - Org Name:NEUROLGLEE THERAPEUTICS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:SWAMINATHA
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-667-4120
Mailing Address - Street 1:33 ARCH ST FL 17
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1424
Mailing Address - Country:US
Mailing Address - Phone:857-557-5777
Mailing Address - Fax:857-557-5778
Practice Address - Street 1:221 1ST AVE SW STE 610
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4504
Practice Address - Country:US
Practice Address - Phone:857-557-5777
Practice Address - Fax:857-557-5778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROGLEE CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty