Provider Demographics
NPI:1043476047
Name:SLEEP DIAGNOSTIC INSTITUTE
Entity type:Organization
Organization Name:SLEEP DIAGNOSTIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY CARE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTONIO
Authorized Official - Middle Name:DELANO
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:CRT
Authorized Official - Phone:301-429-0098
Mailing Address - Street 1:7515 ANNAPOLIS RD
Mailing Address - Street 2:207
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784
Mailing Address - Country:US
Mailing Address - Phone:301-429-0098
Mailing Address - Fax:301-429-0093
Practice Address - Street 1:7515 ANNAPOLIS RD
Practice Address - Street 2:207
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:301-429-0098
Practice Address - Fax:301-429-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL0001393261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center