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General NPI Number Information
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NPI Number | 1457458077
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Entity Type | Organization
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Legal Business Name | SLEEP MANAGEMENT CENTERS LLC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 6350 TECHSTER BLVD STE 2
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City | FORT MYERS
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State | FL
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Zip | 33966-4705
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Country | US
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Telephone | 239-334-8144
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Fax | 239-210-0048
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Provider Business Mailing Address
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Address Line | 6350 TECHSTER BLVD STE 2
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City | FORT MYERS
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State | FL
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Zip | 33966-4705
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Country | US
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Telephone | 239-334-8144
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Fax | 239-210-0048
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA CLARK
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Credential | MSW, RPSGT
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Telephone | 239-334-8144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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