Provider Demographics
NPI:1487359899
Name:MAJESTIC DIAGNOSTICS LLC
Entity type:Organization
Organization Name:MAJESTIC DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-993-2040
Mailing Address - Street 1:14900 SW 30TH ST UNIT 277927
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-7222
Mailing Address - Country:US
Mailing Address - Phone:954-228-1828
Mailing Address - Fax:954-990-6305
Practice Address - Street 1:1701 GREEN RD STE A6
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1074
Practice Address - Country:US
Practice Address - Phone:954-993-2040
Practice Address - Fax:954-990-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2277580OtherCLIA