Provider Demographics
NPI:1669334827
Name:BRAINLOGIX LAB, LLC
Entity type:Organization
Organization Name:BRAINLOGIX LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:KAUILANI SIU-YIU
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-461-3202
Mailing Address - Street 1:13001 FOUNDERS SQUARE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7708
Mailing Address - Country:US
Mailing Address - Phone:321-461-3202
Mailing Address - Fax:321-204-6855
Practice Address - Street 1:3801 AVALON PARK EAST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4902
Practice Address - Country:US
Practice Address - Phone:321-461-3202
Practice Address - Fax:321-204-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty