Indiana Epilepsy and Child Neurology, Inc.

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

Legal business name

INDIANA EPILEPSY AND CHILD NEUROLOGY, INC.

Practice address

4310 Lake Ave
Fort Wayne, IN 46815-7222

Phone

(260) 426-9996

Fax

(260) 426-9996

NPI assigned

Nov 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Don Stauffer

Title

Vice President

Phone

(260) 426-9996

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shari Malini Desilva, MD

  • Neurology Physician
  • Rogers, AR
  • NPI 1629035969
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871668582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157222",
            "telephone_number": "260-426-9996",
            "fax_number": "260-426-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157222",
            "telephone_number": "260-426-9996",
            "fax_number": "260-426-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA EPILEPSY AND CHILD NEUROLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAUFFER",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "260-426-9996",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen R. Incremona, RD
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• Indiana Center for Recovery Outpatient Services LLC
• Indiana Family Home Health Care Corp.
• Indiana Health & Rehabilitation Center (Glenbrook Rehabilitation & Skilled Nursing Center)
• Indiana Health and Rehabilitation Centers (Canterbury Gardens)
• Indiana Health and Rehabilitation Centers (Canterbury Nursing and Rehabilitation Center)
• Indiana Medical Associates, LLC

• Neurology with Special Qualifications in Child Neurology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.