Healthcare Provider Details

I. General information

NPI: 1780546895
Provider Name (Legal Business Name): PATHOGENYX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 SW 132ND ST STE 207
MIAMI FL
33186-7221
US

IV. Provider business mailing address

12855 SW 132ND ST STE 207
MIAMI FL
33186-7221
US

V. Phone/Fax

Practice location:
  • Phone: 786-713-0198
  • Fax:
Mailing address:
  • Phone: 786-713-0198
  • 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: SHAMIL BERSUNKAEV
Title or Position: OWNER
Credential:
Phone: 786-713-0198