NPIMap

Organization Active NPI

Pediatric Neurology PA

  • Pediatric Neurodevelopmental Disabilities Physician
  • Orlando, FL
National Provider Identifier
1417129602
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
License
ME81662 Issued in FL
Legal business name
PEDIATRIC NEUROLOGY PA
Practice address
7485 Sandlake Commons Blvd
Orlando, FL 32819-8034
Phone
(407) 293-1122
Fax
(407) 253-2170
NPI assigned
Mar 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Emmanuel Vega
Title
Administrator
Phone
(407) 293-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0008X ME81662 FL Primary

Addresses

Primary practice location

7485 Sandlake Commons Blvd
Orlando, FL 32819-8034

Mailing address

1245 W Fairbanks Ave Ste 305
Winter Park, FL 32789-4878
Phone (407) 293-1122

Other identifiers 1

IdentifierTypeStateIssuer
280885400MedicaidFL

National Provider Directory

National Provider Directory

Locations

7485 Sandlake Commons Blvd
Orlando, FL 32819
Phone (407) 293-1122

1245 W Fairbanks Ave
Ste 305
Winter Park, FL 32789
Phone (407) 293-1122

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1417129602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 W FAIRBANKS AVE STE 305",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894878",
            "telephone_number": "407-293-1122",
            "fax_number": "407-253-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7485 SANDLAKE COMMONS BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198034",
            "telephone_number": "407-293-1122",
            "fax_number": "407-253-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC NEUROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "VEGA",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-293-1122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "FL",
            "license": "ME81662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280885400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.