Healthcare Provider Details

I. General information

NPI: 1972479608
Provider Name (Legal Business Name): NEUROSLEEP DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 ALSTON BLVD
HAMPSTEAD NC
28443-8124
US

IV. Provider business mailing address

606 ALSTON BLVD
HAMPSTEAD NC
28443-8124
US

V. Phone/Fax

Practice location:
  • Phone: 919-342-7983
  • Fax: 980-427-2948
Mailing address:
  • Phone: 919-342-7983
  • Fax: 980-427-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: BRANDON GORHAM
Title or Position: MEMBER
Credential:
Phone: 919-342-7983