Healthcare Provider Details

I. General information

NPI: 1649593377
Provider Name (Legal Business Name): STULTZ SLEEP STUDY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 CHILDERS RD
BARBOURSVILLE WV
25504-1227
US

IV. Provider business mailing address

PO BOX 457
BARBOURSVILLE WV
25504-0457
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-5380
  • Fax: 304-733-5796
Mailing address:
  • Phone: 304-733-5380
  • Fax: 304-733-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16672
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number16672
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number16672
License Number StateWV

VIII. Authorized Official

Name: DR. DEBRA J STULTZ
Title or Position: MEMBER
Credential: MD
Phone: 304-638-6163