Healthcare Provider Details

I. General information

NPI: 1295109254
Provider Name (Legal Business Name): DELAWARE SLEEP DISORDER CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 DUPONT BLVD SUITE 202
GEORGETOWN DE
19947-1725
US

IV. Provider business mailing address

252 CARTER DR SUITE 200
MIDDLETOWN DE
19709-5855
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-7484
  • Fax: 302-376-8524
Mailing address:
  • Phone: 302-449-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number20151109122
License Number StateDE

VIII. Authorized Official

Name: LYRON A DEPUTY
Title or Position: CEO
Credential: APN
Phone: 302-449-7484