MEDICARE: ALEXA FAUSEY

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	9119257	FL

General Provider Information

NPI Number	:	1265259238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA FAUSEY

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 TAMIAMI TRL
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5508
Country	:	US
Telephone Number	:	941-235-0532
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	08/24/2025

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Directions to “ ALEXA FAUSEY ” Practice Location

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