Provider Demographics
NPI:1356554158
Name:SARASOTA NEUROLOGY P A
Entity type:Organization
Organization Name:SARASOTA NEUROLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:V
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KASSICIEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-955-5858
Mailing Address - Street 1:3501 CATTLEMEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6055
Mailing Address - Country:US
Mailing Address - Phone:941-955-5858
Mailing Address - Fax:941-955-0044
Practice Address - Street 1:3501 CATTLEMEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6055
Practice Address - Country:US
Practice Address - Phone:941-955-5858
Practice Address - Fax:941-955-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS51882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty