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General NPI Number Information
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NPI Number | 1861171050
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Entity Type | Organization
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Legal Business Name | SUNSHINE CLINICAL LAB LLC
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 3600 GALILEO DR STE 104
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City | TRINITY
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State | FL
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Zip | 34655-1795
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Country | US
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Telephone | 631-805-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 GALILEO DR STE 104
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City | TRINITY
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State | FL
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Zip | 34655-1795
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN URALIL
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Credential | CFO
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Telephone | 631-805-4406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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