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General NPI Number Information
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NPI Number | 1699021295
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Entity Type | Organization
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Legal Business Name | SLEEP-WAKE DISORDER CENTER OF DAYTONA PA
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 810 WILDWOOD ST STE 1
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4568
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Country | US
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Telephone | 386-258-7100
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Fax | 386-253-1843
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Provider Business Mailing Address
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Address Line | 810 WILDWOOD ST STE 1
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4568
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Country | US
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Telephone | 386-258-7100
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Fax | 386-253-1843
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Authorized Official
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Title or Position | OWNER
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Name | WAHBA W WAHBA
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Credential | MD
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Telephone | 386-258-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) 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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease 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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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