Healthcare Provider Details

I. General information

NPI: 1346231016
Provider Name (Legal Business Name): SOUTH FLORIDA DIAGNOSTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20020 VETERANS BLVD SUITE 20
PORT CHARLOTTE FL
33954-2114
US

IV. Provider business mailing address

15211 LAUREL LN S
PEMBROKE PINES FL
33027-1330
US

V. Phone/Fax

Practice location:
  • Phone: 941-623-0460
  • Fax: 941-613-0461
Mailing address:
  • Phone: 954-442-9726
  • Fax: 954-442-6817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberHCC6245
License Number StateFL

VIII. Authorized Official

Name: MR. LARRY NIERENBERG
Title or Position: PRESIDENT
Credential:
Phone: 954-442-9726