Provider Demographics
NPI:1770521338
Name:STAYWELL DIABETIC SUPPLIES
Entity type:Organization
Organization Name:STAYWELL DIABETIC SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANTELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-222-3549
Mailing Address - Street 1:1325 NW 93RD CT
Mailing Address - Street 2:SUITE NUMBER B-103
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2857
Mailing Address - Country:US
Mailing Address - Phone:305-436-8945
Mailing Address - Fax:305-436-8946
Practice Address - Street 1:1325 NW 93RD CT
Practice Address - Street 2:SUITE NUMBER B-103
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2857
Practice Address - Country:US
Practice Address - Phone:305-436-8945
Practice Address - Fax:305-436-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL603400-3332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies