Healthcare Provider Details

I. General information

NPI: 1356832349
Provider Name (Legal Business Name): CRESCENT CITY SLEEP AND DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4232 WILLIAMS BLVD STE 111
KENNER LA
70065-2271
US

IV. Provider business mailing address

4232 WILLIAMS BLVD STE 111
KENNER LA
70065-2271
US

V. Phone/Fax

Practice location:
  • Phone: 504-405-5582
  • Fax:
Mailing address:
  • Phone: 504-405-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAZIA NADEEM
Title or Position: OFFICE MANEGER
Credential:
Phone: 504-575-6945