Provider Demographics
NPI:1962615187
Name:NEUROSURGICAL INSTITUTE OF FLORIDA
Entity type:Organization
Organization Name:NEUROSURGICAL INSTITUTE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-325-4873
Mailing Address - Street 1:201 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1402
Mailing Address - Country:US
Mailing Address - Phone:305-325-4873
Mailing Address - Fax:305-325-4883
Practice Address - Street 1:201 BIRD RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1402
Practice Address - Country:US
Practice Address - Phone:305-325-4873
Practice Address - Fax:305-325-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92901207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
16919Medicare PIN
I52517Medicare UPIN