| Coastal Neurology, P.A. | |
|
1833 N. Paris Avenue Port Royal SC 29935-2029 | |
| (843) 522-1420 | |
| (843) 522-1460 |
| Full Name | Coastal Neurology, P.A. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1833 N. Paris Avenue, Port Royal, South Carolina |
| Authorized Official Name and Position | Paul Mazzeo (PRESIDENT) |
| Authorized Official Contact | 8435221420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Neurology, P.A. 1833 N Paris Ave Port Royal SC 29935-2029 Ph: (843) 522-1420 | Coastal Neurology, P.A. 1833 N. Paris Avenue Port Royal SC 29935-2029 Ph: (843) 522-1420 |
| NPI Number | 1750346789 |
|---|---|
| Provider Enumeration Date | 04/20/2006 |
| Last Update Date | 06/10/2026 |
| Certification Date | 06/10/2026 |
| Medicare PECOS PAC ID | 7810894664 |
|---|---|
| Medicare Enrollment ID | O20040107000552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750346789 | NPI | - | NPPES |
| GP1188 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | () | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | () | Secondary |
| Provider Name | Paul Mazzeo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568432185 PECOS PAC ID: 1052218807 Enrollment ID: I20050426000254 |
| Provider Name | Tiffany Williams Rossi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144991357 PECOS PAC ID: 0840674164 Enrollment ID: I20220904000095 |
| Provider Name | Jared Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750769725 PECOS PAC ID: 6800127937 Enrollment ID: I20230517003230 |
| Provider Name | Ashton Marie Giammona |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093609174 PECOS PAC ID: 0648758664 Enrollment ID: I20260201000133 |
| Provider Name | Kristen Michele Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124902309 PECOS PAC ID: 6204319734 Enrollment ID: I20260312003879 |
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