Provider Demographics
NPI:1154556181
Name:STANDLEY, KATHERINE DOLORES (DO)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DOLORES
Last Name:STANDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:13067 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0926
Mailing Address - Country:US
Mailing Address - Phone:813-773-6658
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR STE 510
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6602
Practice Address - Country:US
Practice Address - Phone:813-615-7725
Practice Address - Fax:813-615-7082
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS119072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010202000Medicaid
FLHP487ZMedicare PIN