Provider Demographics
NPI:1174277057
Name:SUN HEALTH DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SUN HEALTH DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DELVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-505-7058
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:ARCADE A
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4855
Mailing Address - Country:US
Mailing Address - Phone:866-719-2757
Mailing Address - Fax:888-736-6370
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD
Practice Address - Street 2:ARCADE A
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4855
Practice Address - Country:US
Practice Address - Phone:866-719-2757
Practice Address - Fax:888-736-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory