MEDICARE: SLEEPWELL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician		FL

General Provider Information

NPI Number	:	1700038361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEPWELL, INC

Provider Business Mailing Address
First Line	:	2508 W. SAINT ISABEL STREET
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-6380
Country	:	US
Telephone Number	:	813-877-2255
Fax Number	:	813-877-6109

Provider Business Practice Location Address
First Line	:	2508 W. SAINT ISABEL STREET
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-6380
Country	:	US
Telephone Number	:	813-877-2255
Fax Number	:	813-877-6109

Authorized Official
Title or Position	:	PD
Name	:	MRS. PRATIMA RAO
Credential	:	MPH
Telephone Number	:	813-841-5862

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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