10D0267882 CLIA NUMBER - SHORES MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 10D0267882
  • Facility Name: SHORES MEDICAL CENTER
  • Facility Address: 3512 SOUTH ATLANTIC AVENUE
    DAYTONA BEACH, FL
    ZIP 32118
  • Facility Phone: 386 767-9544
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GERALD R. WOODARD
  • NPI Number: 1114111440
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0267882
LAB Type Physician Office
Facility Name SHORES MEDICAL CENTER
Street 3512 SOUTH ATLANTIC AVENUE
City DAYTONA BEACH
State FL
ZIP 32118
Phone 386 767-9544
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Physician Office
Lab Director GERALD R. WOODARD

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