Healthcare Provider Details

I. General information

NPI: 1780967430
Provider Name (Legal Business Name): SURGICAL HEALING ARTS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 DIAMOND CENTRE COURT SUITE 1301
FORT MYERS FL
33912
US

IV. Provider business mailing address

6150 DIAMOND CENTRE COURT SUITE 1301
FORT MYERS FL
33912
US

V. Phone/Fax

Practice location:
  • Phone: 239-344-9786
  • Fax: 239-344-9215
Mailing address:
  • Phone: 239-344-9786
  • Fax: 239-344-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS10312
License Number StateFL

VIII. Authorized Official

Name: DR. MOSES SHIEH
Title or Position: CEO
Credential: DO
Phone: 239-344-9786