10D0983197 CLIA NUMBER - DAVENPORT PEDIATRICS PA

Laboratory Demographics

  • CLIA Code: 10D0983197
  • Facility Name: DAVENPORT PEDIATRICS PA
  • Facility Address: 103 PARK PLACE BLVD
    DAVENPORT, FL
    ZIP 33837
  • Facility Phone: 863 421-1855
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIA C. KHAN MD
  • NPI Number: 1558403691
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0983197
LAB Type Physician Office
Facility Name DAVENPORT PEDIATRICS PA
Street 103 PARK PLACE BLVD
City DAVENPORT
State FL
ZIP 33837
Phone 863 421-1855
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/19/2025
Certificate Expiration Date 2/18/2027
Facility Type Physician Office
Lab Director MARIA C. KHAN MD

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