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General NPI Number Information
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NPI Number | 1780183947
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Entity Type | Organization
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Legal Business Name | ANNAPOLIS SLEEP CENTER LLC
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 2451 RIVA RD
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City | ANNAPOLIS
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State | MD
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Zip | 21401
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Country | US
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Telephone | 410-266-1644
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Fax | 410-266-1642
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Provider Business Mailing Address
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Address Line | 2000 MEDICAL PKWY STE 607
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3748
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Country | US
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Telephone | 410-266-1644
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Fax | 410-266-1642
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. MARY BETH SHAKLEE
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Credential |
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Telephone | 410-266-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | D0035494
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License Number State | MD
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