Healthcare Provider Details

I. General information

NPI: 1245780683
Provider Name (Legal Business Name): PEDIATRIC SLEEP AND NEURO CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 FLINT RD
COLUMBUS OH
43235-6420
US

IV. Provider business mailing address

7811 FLINT RD
COLUMBUS OH
43235-6420
US

V. Phone/Fax

Practice location:
  • Phone: 614-446-1820
  • Fax:
Mailing address:
  • Phone: 614-446-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number35.070439
License Number StateOH

VIII. Authorized Official

Name: DR. SAMUEL DZODZOMENYO
Title or Position: OWNER
Credential: MD
Phone: 614-446-1820