Healthcare Provider Details

I. General information

NPI: 1841957115
Provider Name (Legal Business Name): SOUTH FLORIDA SURGICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4399 N NOB HILL RD
SUNRISE FL
33351-5813
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 954-749-0300
  • Fax:
Mailing address:
  • Phone: 954-755-0111
  • Fax:

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