Healthcare Provider Details

I. General information

NPI: 1033835723
Provider Name (Legal Business Name): NORTH FLORIDA SLEEP RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 EAGLE HARBOR PKWY STE 7
FLEMING ISLAND FL
32003-8329
US

IV. Provider business mailing address

1700 EAGLE HARBOR PKWY STE 7
FLEMING ISLAND FL
32003-8329
US

V. Phone/Fax

Practice location:
  • Phone: 904-906-6007
  • Fax: 904-280-6658
Mailing address:
  • Phone: 904-906-6007
  • Fax: 904-280-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KELLY STANDISH-MAYO
Title or Position: DENTIST
Credential: DMD
Phone: 904-505-3311