49D0997393 CLIA NUMBER - SENTARA PEDIATRIC PHYSICIANS - NIMMO

Laboratory Demographics

  • CLIA Code: 49D0997393
  • Facility Name: SENTARA PEDIATRIC PHYSICIANS - NIMMO
  • Facility Address: 2301 GENERAL BOOTH BOULEVARD -SUITE B
    VIRGINIA BEACH, VA
    ZIP 23456
  • Facility Phone: 757 963-5500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FANYA SEAGULL
  • NPI Number: 1326254699
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D0997393
LAB Type Physician Office
Facility Name SENTARA PEDIATRIC PHYSICIANS - NIMMO
Street 2301 GENERAL BOOTH BOULEVARD -SUITE B
City VIRGINIA BEACH
State VA
ZIP 23456
Phone 757 963-5500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2024
Certificate Expiration Date 3/13/2026
Facility Type Physician Office
Lab Director FANYA SEAGULL

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