MEDICARE: KENADEE BURGOYNE

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	PA9120665	FL

General Provider Information

NPI Number	:	1871387019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENADEE BURGOYNE

Provider Business Mailing Address
First Line	:	7331 COLLEGE PKWY STE 300
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5524
Country	:	US
Telephone Number	:	239-337-2003
Fax Number	:	239-337-3168

Provider Business Practice Location Address
First Line	:	7331 COLLEGE PKWY STE 300
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5524
Country	:	US
Telephone Number	:	239-337-2003
Fax Number	:	239-337-3168

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

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	01/07/2026

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7331 COLLEGE PKWY STE 300
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1487629606 — ANDRES MELENDEZ-DEDOS M.D.
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1750338786 — NADIA AMEENA KAZIM M.D.
Practice Location Address:

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Practice Location Address:

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1588608624 — MR. STEPHEN J. LAQUIS M.D.
Practice Location Address:

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Directions to “ KENADEE BURGOYNE ” Practice Location

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