| Carolina Child Neurology, Pllc | |
|
1540 Purdue Dr Ste 101 Fayetteville NC 28303-5510 | |
| (910) 491-2437 | |
| (910) 491-2439 |
| Full Name | Carolina Child Neurology, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1540 Purdue Dr Ste 101, Fayetteville, North Carolina |
| Authorized Official Name and Position | Shalaka Indulkar (MEMBER AND ORGANIZER) |
| Authorized Official Contact | 7182882454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Child Neurology, Pllc 1133 Offshore Dr Fayetteville NC 28305-5250 Ph: (910) 491-2437 | Carolina Child Neurology, Pllc 1540 Purdue Dr Ste 101 Fayetteville NC 28303-5510 Ph: (910) 491-2437 |
| NPI Number | 1780014761 |
|---|---|
| Provider Enumeration Date | 11/12/2013 |
| Last Update Date | 02/19/2019 |
| Medicare PECOS PAC ID | 6800028895 |
|---|---|
| Medicare Enrollment ID | O20140404001324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780014761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0402X | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology | (* (Not Available)) | Primary |
| Provider Name | Shalaka D Indulkar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194919514 PECOS PAC ID: 3173775558 Enrollment ID: I20121211000249 |
| Provider Name | Katlin Lee Yokeley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891306692 PECOS PAC ID: 6800204355 Enrollment ID: I20210421001837 |
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