Healthcare Provider Details

I. General information

NPI: 1871205302
Provider Name (Legal Business Name): DELAWARE SLEEP DISORDER CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEUROLOGY WAY
MILFORD DE
19963-5368
US

IV. Provider business mailing address

620 STANTON CHRISTIANA RD STE 101
NEWARK DE
19713-2134
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-7484
  • Fax:
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 Number
License Number State

VIII. Authorized Official

Name: LYRON ANDRE DEPUTY
Title or Position: OWNER
Credential: NP
Phone: 302-652-5109