Healthcare Provider Details

I. General information

NPI: 1568700284
Provider Name (Legal Business Name): PARADISE SURGICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS STE 308
ST THOMAS VI
00802-3132
US

IV. Provider business mailing address

PO BOX 12390
ST THOMAS VI
00801-5390
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-8881
  • Fax:
Mailing address:
  • Phone: 340-774-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ADAM M SHAPIRO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 340-774-8881