Provider Demographics
NPI: | 1710138805 |
---|---|
Name: | SWEET DREAMS OF ALBANY LLC |
Entity Type: | Organization |
Organization Name: | SWEET DREAMS OF ALBANY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JARED |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | DERANEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CRNA |
Authorized Official - Phone: | 888-728-0882 |
Mailing Address - Street 1: | PO BOX 850001 DEPT 740Q |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32885-4380 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 941-360-1566 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4080 MCGINNIS FERRY RD STE 102 |
Practice Address - Street 2: | |
Practice Address - City: | ALPHARETTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30005-3901 |
Practice Address - Country: | US |
Practice Address - Phone: | 888-728-0882 |
Practice Address - Fax: | 888-512-1507 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-10-07 |
Last Update Date: | 2020-05-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |