Healthcare Provider Details

I. General information

NPI: 1548973431
Provider Name (Legal Business Name): REGENERATIVE SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10113 SUNSET STRIP
SUNRISE FL
33322-2619
US

IV. Provider business mailing address

10113 SUNSET STRIP
SUNRISE FL
33322-2619
US

V. Phone/Fax

Practice location:
  • Phone: 954-530-8507
  • Fax: 954-652-1538
Mailing address:
  • Phone: 954-530-8507
  • Fax: 954-652-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VERONICA VALENTINE
Title or Position: OWNER
Credential: DC
Phone: 954-530-8507