=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487636767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP-WAKE DISORDERS CENTER OF SOUTH FLORIDA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7325 SW 63RD AVE SUITE 203
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-5994
-----------------------------------------------------
Fax | 305-661-9779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6356 MANOR LN SUITE 102
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-5994
-----------------------------------------------------
Fax | 305-661-9779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT B SCHADER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-661-5994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number | HCCR661
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------