MEDICARE: SURGICAL STAFFING DEVELOPMENT AND SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA 9101047	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760777007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL STAFFING DEVELOPMENT AND SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 4722
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-0722
Country	:	US
Telephone Number	:	786-252-2243
Fax Number	:	305-362-3989

Provider Business Practice Location Address
First Line	:	7142 LAUREL LN
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2664
Country	:	US
Telephone Number	:	786-252-2243
Fax Number	:	305-362-3989

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELIZABETH HERNANDEZ
Credential	:
Telephone Number	:	786-252-2243

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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