# SPACE COAST SURGICAL ASSISTING LLC

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

## Provider details

- **NPI number:** 1922404441
- **Authorized official:** MICHAEL A DANCY CSFA, CST (MGR)
- **Authorized official phone:** (321) 890-2022

## Contact information

- **Practice address:** 749 MCDERMOTT AVE, MELBOURNE, FL 32935-3038
- **Practice address phone:** (321) 890-2022
- **Mailing address:** 1270 N WICKHAM RD STE 16-422, MELBOURNE, FL 32935-8923
- **Mailing address phone:** (321) 890-2022

## Taxonomy

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

## Other

- **Enumeration date:** 11/11/2014
- **Last updated:** 11/11/2014