| Tidewater Neurologists And Sleep Disorder Specialist, Inc | |
|
3235 Academy Ave Suite 305 Portsmouth VA 23703-3200 | |
| (757) 686-9300 | |
| (757) 686-1514 |
| Full Name | Tidewater Neurologists And Sleep Disorder Specialist, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3235 Academy Ave, Portsmouth, Virginia |
| Authorized Official Name and Position | Hemang H Shah (OWNER) |
| Authorized Official Contact | 7576869300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Neurologists And Sleep Disorder Specialist, Inc 3235 Academy Ave Ste 305 Portsmouth VA 23703-3200 Ph: (757) 463-5240 | Tidewater Neurologists And Sleep Disorder Specialist, Inc 3235 Academy Ave Suite 305 Portsmouth VA 23703-3200 Ph: (757) 686-9300 |
| NPI Number | 1689623258 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 10/30/2023 |
| Certification Date | 10/30/2023 |
| Medicare PECOS PAC ID | 4688682875 |
|---|---|
| Medicare Enrollment ID | O20060329000783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689623258 | NPI | - | NPPES |
| 200250 | Other | VA | SENTARA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Secondary |
| Provider Name | Hemang H Shah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982654042 PECOS PAC ID: 3274504659 Enrollment ID: I20071101000628 |
| Provider Name | Eric J Goldberg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629028238 PECOS PAC ID: 1951498344 Enrollment ID: I20071101000656 |
| Provider Name | Nachama S Haas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285766444 PECOS PAC ID: 2769669803 Enrollment ID: I20110526000837 |
| Provider Name | Anna Perron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396496360 PECOS PAC ID: 0345634903 Enrollment ID: I20220224000042 |
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