Provider Demographics
NPI:1770210700
Name:SILVERSTARDX LLC
Entity type:Organization
Organization Name:SILVERSTARDX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAXAMILLION
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-579-4888
Mailing Address - Street 1:1070 E BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5509
Mailing Address - Country:US
Mailing Address - Phone:813-579-4888
Mailing Address - Fax:813-579-4889
Practice Address - Street 1:1070 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5509
Practice Address - Country:US
Practice Address - Phone:813-579-4888
Practice Address - Fax:813-579-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory