Healthcare Provider Details

I. General information

NPI: 1265216170
Provider Name (Legal Business Name): SOFLO SURGEONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 MEDICAL PARK BLVD STE 405
WELLINGTON FL
33414-3183
US

IV. Provider business mailing address

611 E WOOLBRIGHT RD APT A301
BOYNTON BEACH FL
33435-6131
US

V. Phone/Fax

Practice location:
  • Phone: 904-334-0910
  • Fax: 561-363-2597
Mailing address:
  • Phone: 904-334-0910
  • Fax: 561-363-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREN MARIE BRANCIFORTE
Title or Position: OPERATIONS ADMIN
Credential:
Phone: 904-334-0910