# BREVARD NEUROLOGY ASSOCIATES PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194704544
- **Authorized official:** MR. WASIM NIAZI MD (CORPORATE OFFICE)
- **Authorized official phone:** (321) 636-8366

## Contact information

- **Practice address:** 1910 ROCKLEDGE BLVD, UNIT 101, ROCKLEDGE, FL 32955
- **Practice address phone:** (321) 636-8366
- **Practice address fax:** (321) 636-3985
- **Mailing address:** 1910 ROCKLEDGE BLVD, UNIT 101, ROCKLEDGE, FL 32955
- **Mailing address phone:** (321) 636-8366
- **Mailing address fax:** (321) 636-3985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | ME58732 | FL | Yes |

## Other

- **Enumeration date:** 01/13/2006
- **Last updated:** 04/12/2013