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Organization

SPACE COAST SURGICAL ASSISTING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL A DANCY CSFA, CST (MGR)
(321) 890-2022
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary

Other

Enumeration date
11/11/2014
Last updated
11/11/2014
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