PEDIATRIC NEUROLOGY PA
NPI 1417129602
Pediatrics - Neurodevelopmental Disabilities in Orlando, FL

Active since March 27, 2008CLIA 10D1093532 · Waiver
7485 SANDLAKE COMMONS BLVD, ORLANDO, FL 32819(407) 293-1122(407) 253-2170 Get Directions Write a Review

NPPES record last updated: August 5, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Pediatric Neurology Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRIC NEUROLOGY PA (NPI 1417129602) is a healthcare organization registered as a neurodevelopmental disabilities in Orlando, Florida and active in the NPI registry since March 2008. The organization holds a CLIA Waiver certificate valid through December 21, 2026 and lists Emmanuel Vega, Administrator, as its authorized official.

NPPES Registry Identity

NPI1417129602
Entity TypeOrganization
Primary Taxonomy2080P0008X
Legal Business NamePEDIATRIC NEUROLOGY PA
Location Address7485 SANDLAKE COMMONS BLVDOrlando, FL 32819-8034
Mailing Address1245 W Fairbanks Ave Ste 305Winter Park, FL 32789-4878 · (407) 293-1122 · Fax (407) 253-2170
Fax(407) 253-2170
Organization SubpartNo
Authorized OfficialEmmanuel VegaAdministrator · (407) 293-1122
Enumeration DateMarch 27, 2008
Last NPPES UpdateAugust 5, 2020
NPPES CertifiedAugust 5, 2020
NPI 1417129602 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPediatrics · Neurodevelopmental DisabilitiesAllopathic & Osteopathic Physicians
Taxonomy Code2080P0008X
License Licensed in FL · ME81662
Definition

A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions.

7485 SANDLAKE COMMONS BLVD, Orlando, FL 32819

Other Identifiers 1

Medicaid280885400FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1093532

Pediatric Neurology PA · Winter Park, FL
Active · expires Dec 21, 2026
CLIA Number10D1093532
Laboratory TypePhysician Office
Certificate Effective DateDecember 22, 2024
Certificate Expiration DateDecember 21, 2026
Laboratory DirectorRonald G. Davis
Laboratory Phone(407) 293-1122
Laboratory LocationPediatric Neurology PA1245 W Fairbanks Ave Suite 200, Winter Park, FL 32789
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Nurse Practitioner (Pediatrics)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Internal Medicine (Endocrinology, Diabetes & Metabolism)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Nurse Practitioner (Family)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Internal Medicine (Endocrinology, Diabetes & Metabolism)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Nurse Practitioner (Family)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819
Nurse Practitioner (Pediatrics)
7485 SANDLAKE COMMONS BLVD
ORLANDO, FL 32819

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pediatric Neurology PA's NPI number?

The NPI number for Pediatric Neurology PA is 1417129602. It was assigned to this organization in the NPPES registry on March 27, 2008.

Where is Pediatric Neurology PA located?

Pediatric Neurology PA is located at 7485 Sandlake Commons Blvd, Orlando, FL 32819. The listed phone number is (407) 293-1122.

What is Pediatric Neurology PA's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neurodevelopmental Disabilities, with taxonomy code 2080P0008X.

Does Pediatric Neurology PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1093532) is associated with this NPI, valid through December 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Pediatric Neurology PA accept?

Health plans from AvMed, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Pediatric Neurology PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Pediatric Neurology PA was last updated on August 5, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.