Healthcare Provider Details

I. General information

NPI: 1487612768
Provider Name (Legal Business Name): PROFESSIONAL SLEEP ANALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 CONFERENCE DR SUITE 5
FORT MYERS FL
33919-4893
US

IV. Provider business mailing address

8931 CONFERENCE DR SUITE 5
FORT MYERS FL
33919-4893
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-0100
  • Fax: 239-278-0110
Mailing address:
  • Phone: 239-278-0100
  • Fax: 239-278-0110

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: MRS. SHERRIE LYNN HAUCK
Title or Position: PRESIDENT
Credential:
Phone: 513-310-3108