Healthcare Provider Details

I. General information

NPI: 1215390422
Provider Name (Legal Business Name): SPECTOR SCIENTIFIC LAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SW 12TH AVE STE 103B
DEERFIELD BEACH FL
33442-3114
US

IV. Provider business mailing address

160 SW 12TH AVE STE 103B
DEERFIELD BEACH FL
33442-3114
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0522
  • Fax: 561-431-2922
Mailing address:
  • Phone: 561-507-0522
  • Fax: 561-431-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ANNA DZEVA
Title or Position: PRESIDENT
Credential:
Phone: 561-507-0522