Healthcare Provider Details

I. General information

NPI: 1003853540
Provider Name (Legal Business Name): DELMARVA SLEEP DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SLEEPY HOLLOW DR SUITE 203
MIDDLETOWN DE
19709-8894
US

IV. Provider business mailing address

104 SLEEPY HOLLOW DR SUITE 203
MIDDLETOWN DE
19709-8894
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-5460
  • Fax: 302-449-5475
Mailing address:
  • Phone: 302-449-5460
  • Fax: 302-449-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number2004206616
License Number StateDE

VIII. Authorized Official

Name: MR. DAVID ANTHONY GODLEWSKI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 302-449-5460