MEDICARE: THE SHED, LLC

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	173F00000X	Sleep Specialist (PhD)

General Provider Information

NPI Number	:	1962788505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SHED, LLC

Provider Business Mailing Address
First Line	:	305 ARIZONA AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2207
Country	:	US
Telephone Number	:	678-702-9192
Fax Number	:	404-687-8468

Provider Business Practice Location Address
First Line	:	305 ARIZONA AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2207
Country	:	US
Telephone Number	:	678-702-9192
Fax Number	:	404-687-8468

Authorized Official
Title or Position	:	VP
Name	:	MRS. KRISTIN BLONDEAU
Credential	:
Telephone Number	:	678-702-9192

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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Directions to “THE SHED, LLC ” Practice Location

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