Healthcare Provider Details

I. General information

NPI: 1043085251
Provider Name (Legal Business Name): FLAGLER DIAGNOSTIC AND SLEEPING DISORDER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W CYPRESS CREEK RD STE 104
FT LAUDERDALE FL
33309-1947
US

IV. Provider business mailing address

1001 W CYPRESS CREEK RD STE 104
FT LAUDERDALE FL
33309-1947
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-6229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLEG CHEBERKO
Title or Position: OWNER
Credential:
Phone: 386-586-6229