Healthcare Provider Details

I. General information

NPI: 1871900233
Provider Name (Legal Business Name): CENTER FOR SKIN CANCER SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 N WICKHAM RD SUITE 105
MELBOURNE FL
32940
US

IV. Provider business mailing address

8057 SPYGLASS HILL RD SUITE 102
MELBOURNE FL
32940-8565
US

V. Phone/Fax

Practice location:
  • Phone: 321-428-4545
  • Fax: 321-421-7898
Mailing address:
  • Phone: 321-428-4545
  • Fax: 321-421-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME88079
License Number StateFL

VIII. Authorized Official

Name: DR. JEANNINE STEIN
Title or Position: OWNER
Credential: MD
Phone: 321-428-4545