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Organization
MID FLORIDA NEURO DAYTONA, LLC
Active
Organization
MID FLORIDA NEURO DAYTONA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARRY VASSILAKIS (OWNER)
(386) 212-8612
Entity
Organization
Contact information
Practice address
1020 MASON AVE, DAYTONA BEACH, FL 32117-4612
(386) 317-5149
Mailing address
807 BEVILLE RD, SOUTH DAYTONA, FL 32119-1824
(386) 456-4878
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
ME91672
FL
Other
Enumeration date
05/16/2018
Last updated
05/16/2018
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