Healthcare Provider Details

I. General information

NPI: 1710207089
Provider Name (Legal Business Name): PARKWAY SLEEP MEDICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PRESTON EXECUTIVE DR SUITE 103
CARY NC
27513-8433
US

IV. Provider business mailing address

130 PRESTON EXECUTIVE DR SUITE 103
CARY NC
27513-8433
US

V. Phone/Fax

Practice location:
  • Phone: 919-462-8081
  • Fax: 919-462-8082
Mailing address:
  • Phone: 919-462-8081
  • Fax: 919-462-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number2010-00247
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KHALEEL M AHMED
Title or Position: SOLE MEMBER
Credential:
Phone: 919-462-8081