03D0969533 CLIA NUMBER - SHAFA MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 03D0969533
  • Facility Name: SHAFA MEDICAL CLINIC
  • Facility Address: 202 E EARLL DR STE 150
    PHOENIX, AZ
    ZIP 85012
  • Facility Phone: 602 248-8258
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA MODESTA KEYHANI MD
  • NPI Number: 1194906925
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D0969533
LAB Type Physician Office
Facility Name SHAFA MEDICAL CLINIC
Street 202 E EARLL DR STE 150
City PHOENIX
State AZ
ZIP 85012
Phone 602 248-8258
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Physician Office
Lab Director AMANDA MODESTA KEYHANI MD

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This page was last updated on: 9/29/2025