Healthcare Provider Details

I. General information

NPI: 1275821811
Provider Name (Legal Business Name): SLEEP WELL BOCA CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9858 CLINT MOORE RD SUITE C111-321
BOCA RATON FL
33496-1034
US

IV. Provider business mailing address

9858 CLINT MOORE RD SUITE C111-321
BOCA RATON FL
33496-1034
US

V. Phone/Fax

Practice location:
  • Phone: 954-326-1356
  • Fax:
Mailing address:
  • Phone: 954-326-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KINNDY L DABEL
Title or Position: OWNER
Credential:
Phone: 954-326-1356