Healthcare Provider Details

I. General information

NPI: 1205690401
Provider Name (Legal Business Name): CLAUDIA LANDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAUDIA RAMIREZ FUENTES

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DEL PRADO BLVD N STE A
CAPE CORAL FL
33909-6303
US

IV. Provider business mailing address

16896 SOL PRESERVE DR
PORT CHARLOTTE FL
33953-2295
US

V. Phone/Fax

Practice location:
  • Phone: 941-257-3417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: