MEDICARE: SHARP DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH8093	OTHER	FL	CHIRO

General Provider Information

NPI Number	:	1366780801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARP DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	3333 S CONGRESS AVE STE 400
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-7346
Country	:	US
Telephone Number	:	561-266-3851
Fax Number	:	561-266-3883

Provider Business Practice Location Address
First Line	:	3333 S CONGRESS AVE STE 400
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-7346
Country	:	US
Telephone Number	:	561-266-3851
Fax Number	:	561-266-3883

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL S FEDER
Credential	:	D.C
Telephone Number	:	561-266-3851

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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