MEDICARE: MY DIAGNOSTICS LLC

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	:	1831868249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	10500 UNIVERSITY CENTER DR STE 153
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6415
Country	:	US
Telephone Number	:	424-333-6273
Fax Number	:	919-341-1256

Provider Business Practice Location Address
First Line	:	10500 UNIVERSITY CENTER DR STE 153
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6415
Country	:	US
Telephone Number	:	424-333-6273
Fax Number	:	919-341-1256

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	RITESH SHAH
Credential	:	OWNER
Telephone Number	:	424-333-6273

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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