Organization
CHOICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANDALYN CHOICE (ADMINISTRATOR)
(972) 891-2522
Entity
Organization
Contact information
Practice address
4002 W PIONEER DR APT 114, IRVING, TX 75061-8157
(972) 891-2522
Mailing address
4002 W PIONEER DR APT 114, IRVING, TX 75061-8157
(972) 891-2522
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2248646
CLIA WAIVER
TX
Enumeration date
01/26/2022
Last updated
01/26/2022
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