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General NPI Number Information
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NPI Number | 1174594584
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Entity Type | Organization
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Legal Business Name | SHERIDAN SURGERY CENTER
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 95 BULLDOG BLVD STE104
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City | MELBOURNE
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State | FL
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Zip | 32901-3332
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Country | US
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Telephone | 321-952-9800
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Fax | 321-952-7889
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Provider Business Mailing Address
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Address Line | 95 BULLDOG BLVD STE104
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City | MELBOURNE
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State | FL
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Zip | 32901-3332
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Country | US
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Telephone | 321-952-9800
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Fax | 321-952-7889
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT SEMINER
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Credential | MD
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Telephone | 321-676-1870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 846
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License Number State | FL
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