Provider Demographics
NPI:1699021295
Name:SLEEP-WAKE DISORDER CENTER OF DAYTONA PA
Entity Type:Organization
Organization Name:SLEEP-WAKE DISORDER CENTER OF DAYTONA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAHBA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-258-7100
Mailing Address - Street 1:810 WILDWOOD ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4568
Mailing Address - Country:US
Mailing Address - Phone:386-258-7100
Mailing Address - Fax:386-253-1843
Practice Address - Street 1:810 WILDWOOD ST
Practice Address - Street 2:STE 1
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4568
Practice Address - Country:US
Practice Address - Phone:386-258-7100
Practice Address - Fax:386-253-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL409BMedicare PIN
FLGL409AMedicare PIN