Healthcare Provider Details

I. General information

NPI: 1649874439
Provider Name (Legal Business Name): SERENITY MOBILE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 HAMMERSLEY AVE
BRONX NY
10469-3024
US

IV. Provider business mailing address

PO BOX 23
BRONX NY
10469-0023
US

V. Phone/Fax

Practice location:
  • Phone: 917-742-8285
  • Fax:
Mailing address:
  • Phone: 917-742-8285
  • Fax:

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: MRS. SHAKEVA BROWN NNAJI
Title or Position: OWNER
Credential:
Phone: 914-563-7372