# SPACE COAST ENDOCRINOLOGY LLC

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

## Provider details

- **NPI number:** 1376682559
- **Authorized official:** SANDI LAROCHE (MSO CREDENTIALING COORDINATOR)
- **Authorized official phone:** (321) 449-4168

## Contact information

- **Practice address:** 835 EXECUTIVE LN, SUITE 110, ROCKLEDGE, FL 32955-8068
- **Practice address phone:** (321) 638-2075
- **Practice address fax:** (321) 638-2234
- **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 |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 04/28/2010