Healthcare Provider Details

I. General information

NPI: 1306833009
Provider Name (Legal Business Name): SOUTH BROWARD ENDOSCOPY L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST SUITE 106
COOPER CITY FL
33026-1505
US

IV. Provider business mailing address

11011 SHERIDAN ST STE 106
HOLLYWOOD FL
33026-1501
US

V. Phone/Fax

Practice location:
  • Phone: 954-435-0101
  • Fax: 954-435-0125
Mailing address:
  • Phone: 954-435-0101
  • Fax: 954-435-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NODILEE JAMES
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-435-0101