Provider Demographics
NPI:1992394266
Name:SUNSHINE LABS
Entity Type:Organization
Organization Name:SUNSHINE LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-863-4676
Mailing Address - Street 1:2900 RACE ST APT 158
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-4171
Mailing Address - Country:US
Mailing Address - Phone:817-863-4676
Mailing Address - Fax:
Practice Address - Street 1:2900 RACE STREET
Practice Address - Street 2:SUITE 158
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-4171
Practice Address - Country:US
Practice Address - Phone:817-863-4676
Practice Address - Fax:469-342-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory