Provider Demographics
NPI:1770209280
Name:WEST FLORIDA NEUROSURGICAL ASSOCIATES P.A.
Entity type:Organization
Organization Name:WEST FLORIDA NEUROSURGICAL ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-617-0001
Mailing Address - Street 1:13910 FIVAY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7130
Mailing Address - Country:US
Mailing Address - Phone:774-671-0001
Mailing Address - Fax:
Practice Address - Street 1:13910 FIVAY RD STE 2
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7130
Practice Address - Country:US
Practice Address - Phone:774-671-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty