Provider Demographics
NPI:1841998622
Name:DELTA WAVE ANESTHESIA, LLC
Entity type:Organization
Organization Name:DELTA WAVE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-573-6280
Mailing Address - Street 1:237 BLUE BILL LN APT D
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3351
Mailing Address - Country:US
Mailing Address - Phone:570-573-6280
Mailing Address - Fax:
Practice Address - Street 1:360 E PULASKI HWY STE 2A
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6595
Practice Address - Country:US
Practice Address - Phone:570-573-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty