Organization
SURGICAL ASSOCIATES OF BREVARD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDI LAROCHE (CREDENTIALING COORDINATOR)
(321) 449-4168
Entity
Organization
Contact information
Practice address
1004 BEVERLY DR, SUITE A, ROCKLEDGE, FL 32955-2851
(321) 637-2150
(321) 637-2155
Mailing address
150 N SYKES CREEK PKWY, # 300, MERRITT ISLAND, FL 32953-3488
(321) 449-4168
(321) 449-4164
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
11/30/2009
Last updated
09/10/2010
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