Healthcare Provider Details

I. General information

NPI: 1174594584
Provider Name (Legal Business Name): SHERIDAN SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BULLDOG BLVD STE104
MELBOURNE FL
32901-3332
US

IV. Provider business mailing address

95 BULLDOG BLVD STE104
MELBOURNE FL
32901-3332
US

V. Phone/Fax

Practice location:
  • Phone: 321-952-9800
  • Fax: 321-952-7889
Mailing address:
  • Phone: 321-952-9800
  • Fax: 321-952-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number846
License Number StateFL

VIII. Authorized Official

Name: SCOTT SEMINER
Title or Position: PRESIDENT
Credential: MD
Phone: 321-676-1870