Provider Demographics
NPI:1215312947
Name:INTEGRATED NEUROSCIENCES OF ORLANDO
Entity type:Organization
Organization Name:INTEGRATED NEUROSCIENCES OF ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-713-6290
Mailing Address - Street 1:7450 DR PHILLIPS BLVD
Mailing Address - Street 2:STE 314
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5119
Mailing Address - Country:US
Mailing Address - Phone:407-757-2523
Mailing Address - Fax:407-757-2530
Practice Address - Street 1:7450 DR PHILLIPS BLVD
Practice Address - Street 2:STE 314
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5119
Practice Address - Country:US
Practice Address - Phone:407-757-2523
Practice Address - Fax:407-757-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106951103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty