# OCEANSIDE ELITE SURGICAL ASSISTING, LLC

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

## Provider details

- **NPI number:** 1780247189
- **Authorized official:** SHELBY ALLISON LANE PA-C (PRESIDENT)
- **Authorized official phone:** (954) 257-7859

## Contact information

- **Practice address:** 3319 NE 15TH CT, FORT LAUDERDALE, FL 33304-1709
- **Practice address phone:** (954) 257-7859
- **Practice address fax:** (954) 616-8063
- **Mailing address:** 3319 NE 15TH CT, FORT LAUDERDALE, FL 33304-1709
- **Mailing address phone:** (954) 257-7859
- **Mailing address fax:** (954) 616-8063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2019
- **Last updated:** 09/16/2019