10D1093532 CLIA NUMBER - PEDIATRIC NEUROLOGY PA

Laboratory Demographics

  • CLIA Code: 10D1093532
  • Facility Name: PEDIATRIC NEUROLOGY PA
  • Facility Address: 1245 W FAIRBANKS AVE SUITE 200
    WINTER PARK, FL
    ZIP 32789
  • Facility Phone: 407 293-1122
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONALD G. DAVIS
  • NPI Number: 1417129602
  • Taxonomy: 2080P0008X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1093532
LAB Type Physician Office
Facility Name PEDIATRIC NEUROLOGY PA
Street 1245 W FAIRBANKS AVE SUITE 200
City WINTER PARK
State FL
ZIP 32789
Phone 407 293-1122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Physician Office
Lab Director RONALD G. DAVIS

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