Provider Type Icon

PEDIATRIC NEUROLOGY PA NPI 1417129602


NPI Information

NPI: 1417129602
Provider Name: PEDIATRIC NEUROLOGY PA
Classification: Pediatrics - 2080P0008X
Entity Type: Organization

Specialization: Neurodevelopmental Disabilities

CLIA Number: 10D1093532

Address:
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL
ZIP 32819
Phone: (407) 293-1122
Get Directions

PEDIATRIC NEUROLOGY PA is a neurodevelopmental disabilities pediatrics in Orlando, FL. The provider is a pediatrician who treats children having developmental delays or learning disorders including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows. PEDIATRIC NEUROLOGY PA NPI is 1417129602. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7485 SANDLAKE COMMONS BLVD
ORLANDO, FL
ZIP 32819-034
Phone: (407) 293-1122
Fax: (407) 253-2170

The provider's authorized official is Emmanuel Vega .
The authorized official title is Administrator and has the following contact phone number (407) 293-1122.

The CLIA number assigned to this NPI record is 10D1093532 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/27/2008 and was last updated on 8/5/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080P0008XPediatricsNeurodevelopmental DisabilitiesME81662FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1280885400MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.