34D1016444 CLIA NUMBER - SHORE FUN PEDIATRICS

Laboratory Demographics

  • CLIA Code: 34D1016444
  • Facility Name: SHORE FUN PEDIATRICS
  • Facility Address: 14 DOCTORS CIRCLE STE 3
    SUPPLY, NC
    ZIP 28462
  • Facility Phone: 910 754-7075
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALICIA HOPE TYNDALL
  • NPI Number: 1750420428
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 34D1016444
LAB Type Physician Office
Facility Name SHORE FUN PEDIATRICS
Street 14 DOCTORS CIRCLE STE 3
City SUPPLY
State NC
ZIP 28462
Phone 910 754-7075
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2025
Certificate Expiration Date 8/27/2027
Facility Type Physician Office
Lab Director ALICIA HOPE TYNDALL

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