Healthcare Provider Details

I. General information

NPI: 1598645426
Provider Name (Legal Business Name): UNIQUE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W OLD US HIGHWAY 441 STE 974
MOUNT DORA FL
32757-3548
US

IV. Provider business mailing address

1536 BAYWOOD VILLAGE CT
MOUNT DORA FL
32757-2100
US

V. Phone/Fax

Practice location:
  • Phone: 334-734-3772
  • Fax:
Mailing address:
  • Phone: 325-734-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: TORI L VINES
Title or Position: OWNER
Credential: PHLEBOTOMIST,
Phone: 334-734-3772