Provider Demographics
NPI:1467106765
Name:PRESTIGIOUS VIP TRANSPORT LLC
Entity Type:Organization
Organization Name:PRESTIGIOUS VIP TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAHEIYA
Authorized Official - Middle Name:SHARONDELE
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:181-350-2306
Mailing Address - Street 1:37146 HIGHLAND BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3234
Mailing Address - Country:US
Mailing Address - Phone:813-502-3067
Mailing Address - Fax:
Practice Address - Street 1:37146 HIGHLAND BLUFF CIR
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3234
Practice Address - Country:US
Practice Address - Phone:813-502-3067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)