23D1078876 CLIA NUMBER - MANJALI S SHASTRY MD PC

Laboratory Demographics

  • CLIA Code: 23D1078876
  • Facility Name: MANJALI S SHASTRY MD PC
  • Facility Address: 1787 S M-52
    OWOSSO, MI
    ZIP 48867
  • Facility Phone: 989 729-4600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANJALI S. SHASTRY
  • NPI Number: 1801990254
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D1078876
LAB Type Physician Office
Facility Name MANJALI S SHASTRY MD PC
Street 1787 S M-52
City OWOSSO
State MI
ZIP 48867
Phone 989 729-4600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Physician Office
Lab Director MANJALI S. SHASTRY

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