Provider Demographics
NPI:1053475988
Name:SLEEPTECH ASSOCIATES
Entity Type:Organization
Organization Name:SLEEPTECH ASSOCIATES
Other - Org Name:STA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEMENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-917-5699
Mailing Address - Street 1:5431 NW 15TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3772
Mailing Address - Country:US
Mailing Address - Phone:954-917-5699
Mailing Address - Fax:954-917-5502
Practice Address - Street 1:5431 NW 15TH ST STE 10
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-3772
Practice Address - Country:US
Practice Address - Phone:954-917-5699
Practice Address - Fax:954-917-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH160603336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0557080003Medicare NSC