10D2288487 CLIA NUMBER - SUN STATE DERMATOLOGY LLC

Laboratory Demographics

  • CLIA Code: 10D2288487
  • Facility Name: SUN STATE DERMATOLOGY LLC
  • Facility Address: 430 LAKE HOWELL RD
    MAITLAND, FL
    ZIP 32751
  • Facility Phone: 407 636-3113
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJIV KIRAN NATHOO
  • NPI Number: 1093496432
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 10D2288487
LAB Type Physician Office
Facility Name SUN STATE DERMATOLOGY LLC
Street 430 LAKE HOWELL RD
City MAITLAND
State FL
ZIP 32751
Phone 407 636-3113
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2025
Certificate Expiration Date 8/24/2027
Facility Type Physician Office
Lab Director RAJIV KIRAN NATHOO

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