MEDICARE: SOUTH FLORIDA SURGICAL SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1407501893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA SURGICAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	3001 CORAL HILLS DR STE 320
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4172
Country	:	US
Telephone Number	:	954-755-0111
Fax Number	:	954-755-0243

Provider Business Practice Location Address
First Line	:	3140 NW MEDICAL CENTER LN STE 120
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4735
Country	:	US
Telephone Number	:	386-755-6796
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK SHACHNER
Credential	:	MD
Telephone Number	:	954-755-0111

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	02/15/2022

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