Healthcare Provider Details

I. General information

NPI: 1881506897
Provider Name (Legal Business Name): SKYLARK SLEEP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SUMMIT AVE STE 314
SAINT PAUL MN
55102-5500
US

IV. Provider business mailing address

784 LINWOOD AVE
SAINT PAUL MN
55105-3322
US

V. Phone/Fax

Practice location:
  • Phone: 612-618-1402
  • Fax:
Mailing address:
  • Phone: 612-618-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAGDEEP BIJWADIA
Title or Position: CHEIF MEDICAL OFFICER
Credential: MD
Phone: 612-618-1402