Healthcare Provider Details

I. General information

NPI: 1104286434
Provider Name (Legal Business Name): CENTER FOR INTEGRATIVE SLEEP MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8037 CORPORATE CENTER DR STE 400
CHARLOTTE NC
28226-4550
US

IV. Provider business mailing address

8037 CORPORATE CENTER DR STE 400
CHARLOTTE NC
28226-4550
US

V. Phone/Fax

Practice location:
  • Phone: 704-659-1052
  • Fax:
Mailing address:
  • Phone: 704-659-1052
  • Fax: 888-869-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2003-00865
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number2003-00865
License Number StateNC

VIII. Authorized Official

Name: DR. JASON ALEXANDER PECK
Title or Position: CEO, FOUNDER, MEDICAL DIRECTOR
Credential: M.D.
Phone: 704-659-1052