Healthcare Provider Details

I. General information

NPI: 1154483352
Provider Name (Legal Business Name): SLEEP DIAGNOSTIC CENTER OF MAYNARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MAIN ST
MAYNARD MA
01754-2504
US

IV. Provider business mailing address

PO BOX 1405
CONCORD MA
01742-1405
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-7772
  • Fax: 978-369-9514
Mailing address:
  • Phone: 978-369-7772
  • Fax: 978-369-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number078055
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number078055
License Number StateMA

VIII. Authorized Official

Name: DR. MEENA MEHTA
Title or Position: OWNER
Credential: MD
Phone: 978-369-7772