MEDICARE: RAVENSONG CLINICAL LABORATORY

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1518653245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVENSONG CLINICAL LABORATORY

Provider Business Mailing Address
First Line	:	1499 FOREST HILL BLVD STE 112
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33406-6050
Country	:	US
Telephone Number	:	407-761-8640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 FOREST HILL BLVD STE 112
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33406-6050
Country	:	US
Telephone Number	:	407-761-8640
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DANIELLE ZIOLO
Credential	:
Telephone Number	:	407-761-8640

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	04/14/2023

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