MEDICARE: SLEEPMANATEE, PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME39816	FL

General Provider Information

NPI Number	:	1821432386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEPMANATEE, PL

Provider Business Mailing Address
First Line	:	5517 21ST AVE W
Second Line	:	STE F
City	:	BRADENTON
State	:	FL
Zip	:	34209-5604
Country	:	US
Telephone Number	:	941-792-8383
Fax Number	:	941-792-8484

Provider Business Practice Location Address
First Line	:	5517 21ST AVE W
Second Line	:	STE F
City	:	BRADENTON
State	:	FL
Zip	:	34209-5604
Country	:	US
Telephone Number	:	941-792-8383
Fax Number	:	941-792-8484

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID E LAW
Credential	:	MD
Telephone Number	:	941-792-8383

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	05/06/2013

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