Provider Demographics
NPI:1578041208
Name:ALLIED SURGICAL OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:ALLIED SURGICAL OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AMBR
Authorized Official - Prefix:
Authorized Official - First Name:STORM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-854-0628
Mailing Address - Street 1:3255 NW 94TH AVE UNIT 8154
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-2009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7201 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2913
Practice Address - Country:US
Practice Address - Phone:954-854-0628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102746363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty