1760801815 NPI number — POUYA ALEXANDER AMELI M.D., M.S.

Table of content: POUYA ALEXANDER AMELI M.D., M.S. (NPI 1760801815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760801815 NPI number — POUYA ALEXANDER AMELI M.D., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMELI
Provider First Name:
POUYA
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABDOLLAHZADEH
Provider Other First Name:
POUYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760801815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-5550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UF NEUROLOGY MCKNIGHT BRAIN INSTITUTE 1149 NEWELL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084A2900X , with the licence number:  ME145264 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: 079928 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: ME145264 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME145264 . This is a "FLORIDA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1760801815 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079928 . This is a "GEORGIA LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 106721700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".