Healthcare Provider Details

I. General information

NPI: 1760189062
Provider Name (Legal Business Name): BEAUTY SLEEP ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S KANNER HWY
STUART FL
34994-4815
US

IV. Provider business mailing address

2750 S KANNER HWY
STUART FL
34994-4815
US

V. Phone/Fax

Practice location:
  • Phone: 772-370-9791
  • Fax:
Mailing address:
  • Phone: 772-370-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIERA DICICCO
Title or Position: OWNER
Credential: APRN
Phone: 772-320-9791