10D2135020 CLIA NUMBER - WILDWOOD DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2135020
  • Facility Name: WILDWOOD DIALYSIS
  • Facility Address: 4713 E STATE ROAD 44 - SUITE 900
    WILDWOOD, FL
    ZIP 34785
  • Facility Phone: 352 330-2009
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SUNDEEP SHAH
  • NPI Number: 1770940769
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 10D2135020
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name WILDWOOD DIALYSIS
Street 4713 E STATE ROAD 44 - SUITE 900
City WILDWOOD
State FL
ZIP 34785
Phone 352 330-2009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SUNDEEP SHAH

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