MEDICARE: MAYPORT MOLECULAR 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	:	1881583920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYPORT MOLECULAR LLC

Provider Business Mailing Address
First Line	:	2550 MAYPORT RD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32233-2872
Country	:	US
Telephone Number	:	904-490-8316
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 MAYPORT RD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32233-2872
Country	:	US
Telephone Number	:	904-490-8316
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SALIDER KUMAR
Credential	:
Telephone Number	:	470-945-4266

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	02/12/2026

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Directions to “MAYPORT MOLECULAR LLC ” Practice Location

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