Healthcare Provider Details

I. General information

NPI: 1104417955
Provider Name (Legal Business Name): VITAL SLEEP CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 HUGHES RD STE 2500
MADISON AL
35758-3026
US

IV. Provider business mailing address

44 HUGHES RD STE 2500
MADISON AL
35758-3026
US

V. Phone/Fax

Practice location:
  • Phone: 256-464-2920
  • Fax: 256-542-3200
Mailing address:
  • Phone: 256-464-2920
  • Fax: 256-542-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LEELASRI VANGURU
Title or Position: DIRECTOR
Credential:
Phone: 256-464-2920