Provider Demographics
NPI:1871611749
Name:ST AUGUSTINE NEUROLOGY PA
Entity type:Organization
Organization Name:ST AUGUSTINE NEUROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUEYANG
Authorized Official - Middle Name:
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-824-2201
Mailing Address - Street 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5793
Mailing Address - Country:US
Mailing Address - Phone:904-824-2201
Mailing Address - Fax:904-824-2373
Practice Address - Street 1:208 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-824-2201
Practice Address - Fax:904-824-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97839261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346249455OtherNPI FOR JUEYANG WEI, MD
H62455Medicare UPIN
1346249455OtherNPI FOR JUEYANG WEI, MD