MEDICARE: SECURE LABS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Q00000X	Pathology Specialist/Technologist
2	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1437903911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE LABS

Provider Business Mailing Address
First Line	:	850 S 21ST ST STE M
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4846
Country	:	US
Telephone Number	:	754-215-6822
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 S 21ST ST STE M
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4846
Country	:	US
Telephone Number	:	754-215-6822
Fax Number	:	877-586-9380

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHATONDRA SCOTT
Credential	:	PHLEBOTOMIST
Telephone Number	:	772-295-7157

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	05/24/2026

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Directions to “SECURE LABS ” Practice Location

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