# SHORESIDE MEDICAL CENTER LLC

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

## Provider details

- **NPI number:** 1518371996
- **Authorized official:** MS. TRACI LW POSTELL (CEO)
- **Authorized official phone:** (386) 316-4111

## Contact information

- **Practice address:** 419 EAST THIRD AVE, NEW SMYRNA BEACH, FL 32169
- **Practice address phone:** (386) 957-3800
- **Practice address fax:** (386) 426-5939
- **Mailing address:** 449 ROCKEFELLER DR, NEW SMYRNA, FL 32168-8937
- **Mailing address phone:** (386) 957-3800
- **Mailing address fax:** (386) 426-5939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | OS8699 | FL | Yes |

## Other

- **Enumeration date:** 06/13/2014
- **Last updated:** 06/13/2014