10D0962966 CLIA NUMBER - SUDARSAN KAMISETTY MD PA

Laboratory Demographics

CLIA Number: 10D0962966

Facility Name: SUDARSAN KAMISETTY MD PA

Facility Address:
681 W LUMSDEN RD
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 655-7726

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376793331

Taxonomy: 2080A0000X - Pediatrics
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	10D0962966
LAB Type	Physician Office
Facility Name	SUDARSAN KAMISETTY MD PA
Street	681 W LUMSDEN RD
City	BRANDON
State	FL
ZIP	33511
Phone	813 655-7726
CertificateType	4
CertificateEffectiveDate	7/19/2023
CertificateExpirationDate	7/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024