Provider Demographics
NPI:1558137604
Name:SURGICAL & SLEEP SOLUTIONS PLLC
Entity type:Organization
Organization Name:SURGICAL & SLEEP SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNDA
Authorized Official - Middle Name:ELYSE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:386-837-1236
Mailing Address - Street 1:400 TREEMONTE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7978
Mailing Address - Country:US
Mailing Address - Phone:386-837-1236
Mailing Address - Fax:
Practice Address - Street 1:400 TREEMONTE DR STE A
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7978
Practice Address - Country:US
Practice Address - Phone:386-837-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery