| Neurology Clinic Pa | |
|
1333 Pine St Melbourne FL 32901-3116 | |
| (321) 984-9400 | |
| (321) 984-8782 |
| Full Name | Neurology Clinic Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1333 Pine St, Melbourne, Florida |
| Authorized Official Name and Position | David J Packey (PRESIDENT) |
| Authorized Official Contact | 3219849400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurology Clinic Pa 1333 Pine St Melbourne FL 32901-3116 Ph: (321) 984-9400 | Neurology Clinic Pa 1333 Pine St Melbourne FL 32901-3116 Ph: (321) 984-9400 |
| NPI Number | 1457468548 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 08/31/2010 |
| Medicare PECOS PAC ID | 1658377676 |
|---|---|
| Medicare Enrollment ID | O20061016000361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457468548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Jill W Miller |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417049719 PECOS PAC ID: 3375517378 Enrollment ID: I20090211000340 |
| Provider Name | David J Packey |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316944788 PECOS PAC ID: 3375667660 Enrollment ID: I20120213000182 |
| Provider Name | Krystal L Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679013486 PECOS PAC ID: 9335406339 Enrollment ID: I20171129002669 |
| Provider Name | Stephanie Newberry-angell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144715871 PECOS PAC ID: 3971843582 Enrollment ID: I20190319000410 |
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