Provider Demographics
NPI:1942898119
Name:PARKSBIO LAB, LLC
Entity Type:Organization
Organization Name:PARKSBIO LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEKHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-274-0102
Mailing Address - Street 1:791 PARK OF COMMERCE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:791 PARK OF COMMERCE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3630
Practice Address - Country:US
Practice Address - Phone:267-566-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107630OtherMEDICAL LICENSE