Provider Demographics
NPI:1780183947
Name:ANNAPOLIS SLEEP CENTER LLC
Entity Type:Organization
Organization Name:ANNAPOLIS SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-266-1644
Mailing Address - Street 1:2000 MEDICAL PKWY STE 607
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3748
Mailing Address - Country:US
Mailing Address - Phone:410-266-1644
Mailing Address - Fax:410-266-1642
Practice Address - Street 1:2451 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-1644
Practice Address - Fax:410-266-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035494261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic