=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740646512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY SLEEP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2016
-----------------------------------------------------
Last Update Date | 07/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5225 HICKORY PARK DR STE A
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-922-1516
-----------------------------------------------------
Fax | 540-765-3369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5225 HICKORY PARK DR STE A
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-922-1516
-----------------------------------------------------
Fax | 540-765-3369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID NEEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-806-3429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173F00000X
-----------------------------------------------------
Taxonomy Name | Sleep Specialist (PhD)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------