Provider Demographics
NPI:1184188690
Name:FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
Entity Type:Organization
Organization Name:FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEBERKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-607-1191
Mailing Address - Street 1:1001 W CYPRESS CRK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1947
Mailing Address - Country:US
Mailing Address - Phone:954-306-3760
Mailing Address - Fax:
Practice Address - Street 1:1001 W CYPRESS CRK RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1947
Practice Address - Country:US
Practice Address - Phone:954-306-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018211800Medicaid
FL8433OtherAHCA LICENSE