Healthcare Provider Details

I. General information

NPI: 1356257471
Provider Name (Legal Business Name): SLEEP MEDICINE NY PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EXECUTIVE WAY STE 203
PONTE VEDRA BEACH FL
32082-2781
US

IV. Provider business mailing address

100 EXECUTIVE WAY STE 203
PONTE VEDRA BEACH FL
32082-2781
US

V. Phone/Fax

Practice location:
  • Phone: 844-314-3052
  • Fax: 844-841-8454
Mailing address:
  • Phone: 844-314-3052
  • Fax: 844-841-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEENA MEHTA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 844-314-3052