Provider Demographics
NPI:1144897133
Name:SHADES OF LIFE LABS LLC
Entity type:Organization
Organization Name:SHADES OF LIFE LABS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-472-5434
Mailing Address - Street 1:138 S ROSEMONT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4336
Mailing Address - Country:US
Mailing Address - Phone:757-672-3507
Mailing Address - Fax:
Practice Address - Street 1:138 S ROSEMONT RD STE 210
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4336
Practice Address - Country:US
Practice Address - Phone:757-431-3000
Practice Address - Fax:757-210-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory