Provider Demographics
NPI:1588378285
Name:VEIN SHARK LLC
Entity type:Organization
Organization Name:VEIN SHARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENOVESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-742-7542
Mailing Address - Street 1:2435 US HIGHWAY 19 STE 221
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3918
Mailing Address - Country:US
Mailing Address - Phone:844-742-7542
Mailing Address - Fax:
Practice Address - Street 1:2435 US HIGHWAY 19 STE 221
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3918
Practice Address - Country:US
Practice Address - Phone:844-742-7542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory