Healthcare Provider Details

I. General information

NPI: 1548751498
Provider Name (Legal Business Name): PULMONARY CRITICAL CARE AND SLEEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 204
ATLANTIS FL
33462-6637
US

IV. Provider business mailing address

5401 S CONGRESS AVE STE 204
ATLANTIS FL
33462-6637
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-4118
  • Fax: 561-967-3463
Mailing address:
  • Phone: 561-967-4118
  • Fax: 561-967-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY CAVENDER
Title or Position: ACCESS MANAGER - ADMINISTRATOR
Credential:
Phone: 561-967-4118