Healthcare Provider Details

I. General information

NPI: 1831051721
Provider Name (Legal Business Name): QUANTARA CLINICAL & DIAGNOSTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N WICKHAM RD STE 103-526
MELBOURNE FL
32940-2028
US

IV. Provider business mailing address

6300 N WICKHAM RD STE 103-526
MELBOURNE FL
32940-2028
US

V. Phone/Fax

Practice location:
  • Phone: 321-400-8871
  • Fax: 772-212-8697
Mailing address:
  • Phone: 321-352-6609
  • Fax: 321-400-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JINNAIL MONIQUE SESSIONS-HOUSTON
Title or Position: DIRECTOR
Credential: APRN
Phone: 321-352-6609