Healthcare Provider Details

I. General information

NPI: 1093036618
Provider Name (Legal Business Name): NEUROLOGY AND SLEEP CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 17TH ST STE 3
SAINT CLOUD FL
34769-6098
US

IV. Provider business mailing address

PO BOX 10
OCOEE FL
34761-0010
US

V. Phone/Fax

Practice location:
  • Phone: 734-353-9152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TARIQ B IRFAN
Title or Position: OWNER
Credential: MD
Phone: 734-353-9152