1295109254 NPI number — DELAWARE SLEEP DISORDER CENTERS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295109254 NPI number — DELAWARE SLEEP DISORDER CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE SLEEP DISORDER CENTERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295109254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
252 CARTER DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-5855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-449-7484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20930 DUPONT BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19947-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-449-7484
Provider Business Practice Location Address Fax Number:
302-376-8524
Provider Enumeration Date:
11/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DEPUTY
Authorized Official First Name:
LYRON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
302-449-7484

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  20151109122 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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