MEDICARE: MRS. SADY M. REGO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9101759	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104892975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SADY M. REGO PA-C

Provider Business Mailing Address
First Line	:	15051 S TAMIAMI TRL STE 203
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5182
Country	:	US
Telephone Number	:	239-437-8810
Fax Number	:	239-313-2555

Provider Business Practice Location Address
First Line	:	2366 SURFSIDE BLVD # C-111
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3180
Country	:	US
Telephone Number	:	239-360-2795
Fax Number	:	239-360-2796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/20/2018

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