10D2314560 CLIA NUMBER - MY WELLNESS PRACTICE

Laboratory Demographics

  • CLIA Code: 10D2314560
  • Facility Name: MY WELLNESS PRACTICE
  • Facility Address: 12505 ORANGE DRIVE SUITE 905
    DAVIE, FL
    ZIP 33330
  • Facility Phone: 954 839-6002
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUMAIRA JAGVANI
  • NPI Number: 1710734975
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2314560
LAB Type Physician Office
Facility Name MY WELLNESS PRACTICE
Street 12505 ORANGE DRIVE SUITE 905
City DAVIE
State FL
ZIP 33330
Phone 954 839-6002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2024
Certificate Expiration Date 11/21/2026
Facility Type Physician Office
Lab Director SUMAIRA JAGVANI

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