CAROLINA CHILD NEUROLOGY, PLLC (NPI# 1780014761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780014761 |
| Entity Type | Organization |
| Organization Name | CAROLINA CHILD NEUROLOGY, PLLC |
| Practice Address |
1540 Purdue Dr Ste 101 Fayetteville NC 28303-5510 |
| Mailing Address |
1133 Offshore Dr Fayetteville NC 28305-5250 |
| Practice Telephone | 9104912437 |
| Practice Fax Number | 9104912439 |
| Mailing Telephone | 9104912437 |
| Mailing Fax Number | 9104912439 |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2019-02-19 |
| Authorized Official Name | DR. SHALAKA INDULKAR (MEMBER AND ORGANIZER) |
| Authorized Official Telephone | 7182882454 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1220 Walter Reed Rd, Fayetteville, NC 283044430 | 7182882454 | 9103398905 |
| Street Address |
1540 PURDUE DR STE 101 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28303-5510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194919514 | Shalaka D Indulkar | Pediatrics | 1540 Purdue Dr Ste 101, Fayetteville, NC 28303-5510 | 2007-08-29 |
| 1891306692 | Katlin Lee Yokeley | Nurse Practitioner | 1540 Purdue Dr Ste 101, Fayetteville, NC 28303-5510 | 2020-08-14 |
| 1437570140 | Autumn Bixler | Physician Assistant | 1540 Purdue Dr Ste 101, Fayetteville, NC 28303-5510 | 2013-12-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404496 | Matthew Pace | Physician Assistant | Bldg 5-4257 Bastogne St, Fort Bragg, NC 28303 | 2020-07-20 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1932746229 | Julie Harriss | Specialist/Technologist | Bldg E 4062, Canopy Lane, Fort Bragg, NC 28303 | 2019-12-05 |
| 1235780354 | Helen Delores Johnson | Technician | 261 Pierron Dr, Fayetteville, NC 28303 | 2019-09-20 |
| 1922655075 | Andrea Margaret Hutnam | Technician | 714 Shortridge Rd, Fayetteville, NC 28303 | 2019-08-23 |
| 1225695273 | Breona Lister | Dental Hygienist | 38 17 Gruber Rd, Fort Bragg, NC 28303 | 2019-05-24 |
| 1780148957 | Brian K Cox Sr. | Occupational Therapy Assistant | 5300 Ramsey St, Fayetteville, NC 28303 | 2019-01-22 |
| 1730670902 | Michael Sadtler | Counselor | 804 Stamper Rd Ste 101, Fayetteville, NC 28303 | 2018-05-23 |
| 1104320399 | Tia Porterfield | Counselor | 2018 Fort Bragg Rd Ste 112a, Fayetteville, NC 28303 | 2018-03-21 |
| 1154835577 | Jessica Bass Bosworth | Psychologist | 3415 Youngstown Dr, Fayetteville, NC 28303 | 2017-11-21 |
| Find all providers in zip 28303 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962473033 | David Jay Jaffe | Psychiatry & Neurology | 508 Sandhurst Dr, A, Fayetteville, NC 28304-4434 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033675079 | Novant Medical Group Inc | Psychiatry & Neurology | 1918 Randolph Rd Ste 320, Charlotte, NC 28207-1109 | 2019-02-14 |
| 1740547496 | Dmitry Tchapyjnikov | Psychiatry & Neurology | Dept of Pediatrics Duke University Medical Ctr, 2301 Erwin Rd., Children's Health Center, Duke Universi, Durham, NC 27710-0001 | 2012-04-19 |
| 1043525280 | Cmc-northeast, Inc. | Psychiatry & Neurology | 6600 Wilkinson Blvd, Carolinas Pediatric Neurology Care - Holy Angels, Belmont, NC 28012-2796 | 2010-08-12 |
| 1750610689 | Virinder Nohria | Psychiatry & Neurology | 111 Skyline View Rd, Franklin, NC 28734-4769 | 2009-12-24 |
| 1144463993 | Monica Elizabeth Lemmon | Psychiatry & Neurology | Dumc 3936, Durham, NC 27710-6667 | 2009-04-09 |
| 1245431600 | Yael Shiloh-malawsky | Psychiatry & Neurology | 170 Manning Dr., Department of Neurology Cb#7025, Chapel Hill, NC 27514-4220 | 2007-05-31 |
| 1598795635 | Kadry R Allaboun | Psychiatry & Neurology | 115 Foothills Dr, Morganton, NC 28655-5152 | 2006-07-04 |
| 1558368936 | Susan B Boutilier | Psychiatry & Neurology | 2280 Hemby Ln, Greenville, NC 27834-3773 | 2005-06-30 |
| 1164987616 | Novant Medical Group Inc | Psychiatry & Neurology | 311 Coddle Market Dr Nw, Ste 200, Concord, NC 28027-2432 | 2019-02-08 |
| 1437629664 | Mission Community Anesthesiology Specialists LLC | Psychiatry & Neurology | 890 Hendersonville Rd Ste 200, Asheville, NC 28803-2997 | 2018-11-30 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 28303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.