Healthcare Provider Details

I. General information

NPI: 1639629876
Provider Name (Legal Business Name): FALCON SLEEP AND NEURODIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 METROWEST BLVD STE 104
ORLANDO FL
32835-7629
US

IV. Provider business mailing address

6000 METROWEST BLVD STE 104
ORLANDO FL
32835-7629
US

V. Phone/Fax

Practice location:
  • Phone: 407-365-3033
  • Fax: 407-365-3034
Mailing address:
  • Phone: 407-365-3033
  • Fax: 407-365-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. AMIN U REHMAN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 407-365-3033