# BREVARD VASCULAR ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184806630
- **Authorized official:** SANDI LAROCHE (MSO CREDENTIALING COORDINATOR)
- **Authorized official phone:** (321) 449-4168

## Contact information

- **Practice address:** 1004 BEVERLY DR, SUITE D, ROCKLEDGE, FL 32955-2851
- **Practice address phone:** (321) 637-4710
- **Practice address fax:** (321) 637-4715
- **Mailing address:** 150 N SYKES CREEK PKWY, SUITE 300, MERRITT ISLAND, FL 32953-3488
- **Mailing address phone:** (321) 449-4168
- **Mailing address fax:** (321) 449-4164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | ME91509 | FL | Yes |

## Other

- **Enumeration date:** 11/27/2007
- **Last updated:** 08/04/2010