Provider Demographics
NPI:1366598435
Name:SHELLCOAST SURGICAL FIRST ASSISTING INC
Entity type:Organization
Organization Name:SHELLCOAST SURGICAL FIRST ASSISTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:239-772-9841
Mailing Address - Street 1:313 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1528
Mailing Address - Country:US
Mailing Address - Phone:239-772-9841
Mailing Address - Fax:239-772-9841
Practice Address - Street 1:313 SE 6TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1528
Practice Address - Country:US
Practice Address - Phone:239-772-9841
Practice Address - Fax:239-772-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1559892163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty