Shoreside Medical Center LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OS8699 Issued in FL

Legal business name

SHORESIDE MEDICAL CENTER LLC

Practice address

419 East Third Ave
New Smyrna Beach, FL 32169

Phone

(386) 957-3800

Fax

(386) 426-5939

NPI assigned

Jun 13, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Traci LW Postell

Title

Ceo

Phone

(386) 316-4111

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402617600000",
    "number": "1518371996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "449 ROCKEFELLER DR",
            "city": "NEW SMYRNA",
            "state": "FL",
            "postal_code": "321688937",
            "telephone_number": "386-957-3800",
            "fax_number": "386-426-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 EAST THIRD AVE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "32169",
            "telephone_number": "386-957-3800",
            "fax_number": "386-426-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORESIDE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-13",
        "last_updated": "2014-06-13",
        "status": "A",
        "authorized_official_last_name": "POSTELL",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "LW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-316-4111",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS8699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seaside Counseling, LLC
• Jesse Selzer
• Yogesh H Shah, M.D.
• Nicole Alexandra Sharp
• Timothy S Shaw, PHD
• Andrew Ryan Shy, DC
• David H Sienkiewicz, RMHCI
• Kenneth M Simon, D.O.
• Phillip M Sinaikin, M.D.
• Robert Singleton, HAS

• General Practice Physician in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.