Provider Demographics
NPI:1649442047
Name:EAST SHORE NEUROLOGY PA
Entity type:Organization
Organization Name:EAST SHORE NEUROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-757-7776
Mailing Address - Street 1:240 N WICKHAM RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8663
Mailing Address - Country:US
Mailing Address - Phone:321-757-7776
Mailing Address - Fax:321-757-7343
Practice Address - Street 1:240 N WICKHAM RD STE 110
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8663
Practice Address - Country:US
Practice Address - Phone:321-757-7776
Practice Address - Fax:321-757-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48156AMedicare PIN
FLI16933Medicare UPIN