10D1036668 CLIA NUMBER - TAKE SHAPE SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D1036668
  • Facility Name: TAKE SHAPE SURGERY CENTER LLC
  • Facility Address: 4161 NW 5TH ST STE 100
    PLANTATION, FL
    ZIP 33317
  • Facility Phone: 954 585-3800
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RUSSELL F. SASSANI
  • NPI Number: 1972609816
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 10D1036668
LAB Type Ambulatory Surgery Center
Facility Name TAKE SHAPE SURGERY CENTER LLC
Street 4161 NW 5TH ST STE 100
City PLANTATION
State FL
ZIP 33317
Phone 954 585-3800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Ambulatory Surgery Center
Lab Director RUSSELL F. SASSANI

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