Healthcare Provider Details

I. General information

NPI: 1407501604
Provider Name (Legal Business Name): SOUTH FLORIDA SURGICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 PEMBROKE RD STE 312
MIRAMAR FL
33027-2544
US

IV. Provider business mailing address

3001 CORAL HILLS DR STE 320
CORAL SPRINGS FL
33065-4172
US

V. Phone/Fax

Practice location:
  • Phone: 786-773-5306
  • Fax:
Mailing address:
  • Phone: 954-755-0111
  • Fax: 954-755-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK SHACHNER
Title or Position: OWNER
Credential: MD
Phone: 954-755-0111