Provider Demographics
NPI:1922253756
Name:MIAMI SHORES HAND & ORTHOPAEDIC SURGICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:MIAMI SHORES HAND & ORTHOPAEDIC SURGICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THESSELON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-696-2100
Mailing Address - Street 1:PO BOX 381037
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33238-1037
Mailing Address - Country:US
Mailing Address - Phone:306-696-2100
Mailing Address - Fax:305-696-0025
Practice Address - Street 1:1190 NW 95TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2063
Practice Address - Country:US
Practice Address - Phone:305-696-2100
Practice Address - Fax:305-695-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101703207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty