Healthcare Provider Details

I. General information

NPI: 1033217997
Provider Name (Legal Business Name): PROFESSIONAL SLEEP DIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

IV. Provider business mailing address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

V. Phone/Fax

Practice location:
  • Phone: 917-803-3470
  • Fax: 336-217-0802
Mailing address:
  • Phone: 917-803-3470
  • Fax: 336-217-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN E LUPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 877-550-2949