Provider Demographics
NPI:1902101199
Name:COMMONWEALTH NEUROLOGY & SLEEP CENTER
Entity Type:Organization
Organization Name:COMMONWEALTH NEUROLOGY & SLEEP CENTER
Other - Org Name:COMMONWEALTH NEUROSCIENCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIDHIRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-236-5366
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-2485
Mailing Address - Country:US
Mailing Address - Phone:859-236-5366
Mailing Address - Fax:859-236-6754
Practice Address - Street 1:439 W WALNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1877
Practice Address - Country:US
Practice Address - Phone:859-236-5366
Practice Address - Fax:859-236-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42286207RS0012X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P100043406Medicare PIN