Healthcare Provider Details

I. General information

NPI: 1790566016
Provider Name (Legal Business Name): HIMMARSHEE PLASTIC SURGERY PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SE 2ND ST STE 100
FORT LAUDERDALE FL
33301-3639
US

IV. Provider business mailing address

717 SE 2ND ST STE 100
FORT LAUDERDALE FL
33301-3639
US

V. Phone/Fax

Practice location:
  • Phone: 954-707-5158
  • Fax:
Mailing address:
  • Phone: 954-707-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SAVANNAH MOON
Title or Position: CO OWNER/PRESIDENT
Credential: DO
Phone: 954-707-5158