Healthcare Provider Details

I. General information

NPI: 1972883643
Provider Name (Legal Business Name): CLEARCHOICE DIABETIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 AVENUE L
DELRAY BEACH FL
33483-4652
US

IV. Provider business mailing address

145 AVENUE L
DELRAY BEACH FL
33483-4652
US

V. Phone/Fax

Practice location:
  • Phone: 561-908-5981
  • Fax: 561-243-1965
Mailing address:
  • Phone: 561-908-5981
  • Fax: 561-243-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. SEAN MICHAEL SONNIE
Title or Position: PRESIDENT
Credential:
Phone: 561-908-5981