Provider Demographics
NPI:1497704985
Name:TAKE SHAPE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:TAKE SHAPE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SASSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-585-3800
Mailing Address - Street 1:4161 NW 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-585-3800
Mailing Address - Fax:954-585-6100
Practice Address - Street 1:4161 NW 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-585-3800
Practice Address - Fax:954-585-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1224208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1452Medicare ID - Type Unspecified
F89993Medicare UPIN