Healthcare Provider Details

I. General information

NPI: 1225339807
Provider Name (Legal Business Name): CHILDREN'S LUNG AND SLEEP SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5251 W CAMPBELL AVE SUITE 110
PHOENIX AZ
85031-1715
US

IV. Provider business mailing address

PO BOX 540326
ORLANDO FL
32854-0326
US

V. Phone/Fax

Practice location:
  • Phone: 866-383-0556
  • Fax: 877-898-9443
Mailing address:
  • Phone: 866-383-0556
  • Fax: 877-898-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number43211
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number43211
License Number StateAZ

VIII. Authorized Official

Name: AKINYEMI O AJAYI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 866-383-0556