Provider Demographics
NPI:1407677297
Name:SENTINEL NEURO LLC
Entity type:Organization
Organization Name:SENTINEL NEURO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROSSS
Authorized Official - Suffix:III
Authorized Official - Credentials:CNIM
Authorized Official - Phone:813-205-3139
Mailing Address - Street 1:9615 RAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5662
Mailing Address - Country:US
Mailing Address - Phone:813-205-3139
Mailing Address - Fax:
Practice Address - Street 1:9615 RAIDEN LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5662
Practice Address - Country:US
Practice Address - Phone:813-205-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty