Healthcare Provider Details

I. General information

NPI: 1124662671
Provider Name (Legal Business Name): ANDERSON SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 LEWISTON ST
ORLANDO FL
32812-8888
US

IV. Provider business mailing address

PO BOX 471
OCOEE FL
34761-0471
US

V. Phone/Fax

Practice location:
  • Phone: 860-416-7018
  • Fax:
Mailing address:
  • Phone: 860-416-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ANDERSON
Title or Position: OWNER
Credential: CSFA
Phone: 860-416-7018