Provider Demographics
NPI:1932972163
Name:S&D CLINICAL RESEARCH.LLC
Entity Type:Organization
Organization Name:S&D CLINICAL RESEARCH.LLC
Other - Org Name:S@D CLINICAL RESEARCH.LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SORAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAYO LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-326-5615
Mailing Address - Street 1:8140 COLLEGE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5189
Mailing Address - Country:US
Mailing Address - Phone:786-326-5615
Mailing Address - Fax:239-722-1196
Practice Address - Street 1:8140 COLLEGE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5189
Practice Address - Country:US
Practice Address - Phone:786-326-5615
Practice Address - Fax:239-722-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112533200Medicaid