Healthcare Provider Details

I. General information

NPI: 1073980348
Provider Name (Legal Business Name): COMPREHENSIVE NEUROLOGY AND SLEEP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W THOMAS RD
PHOENIX AZ
85037-3332
US

IV. Provider business mailing address

PO BOX 9700
PHOENIX AZ
85068-9700
US

V. Phone/Fax

Practice location:
  • Phone: 646-275-4808
  • Fax:
Mailing address:
  • Phone: 646-275-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number006488
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number006488
License Number StateAZ

VIII. Authorized Official

Name: MAYA F. VAYSBROT
Title or Position: MANAGER/MEMBER/EMPLOYEE
Credential: D.O.
Phone: 646-275-4808