Healthcare Provider Details

I. General information

NPI: 1598609893
Provider Name (Legal Business Name): KEYSTONE CLINICAL DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 HUMMINGBIRD WAY
MELBOURNE FL
32940-7883
US

IV. Provider business mailing address

3034 HUMMINGBIRD WAY
MELBOURNE FL
32940-7883
US

V. Phone/Fax

Practice location:
  • Phone: 267-308-5058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RACHEL CHEUNG
Title or Position: PRESIDENT
Credential:
Phone: 267-308-5058