Provider Demographics
NPI:1386366763
Name:THE HEADACHE CLINIC
Entity type:Organization
Organization Name:THE HEADACHE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AAMIR
Authorized Official - Middle Name:SHAHID
Authorized Official - Last Name:KHATTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-000-0000
Mailing Address - Street 1:1942 W COUNTY ROAD 419 STE 1050
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-9024
Mailing Address - Country:US
Mailing Address - Phone:321-451-2576
Mailing Address - Fax:
Practice Address - Street 1:1942 W COUNTY ROAD 419 STE 1050
Practice Address - Street 2:
Practice Address - City:CHULUOTA
Practice Address - State:FL
Practice Address - Zip Code:32766-9024
Practice Address - Country:US
Practice Address - Phone:321-451-2576
Practice Address - Fax:407-255-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty