Healthcare Provider Details

I. General information

NPI: 1649707621
Provider Name (Legal Business Name): TATIANA ZANGANEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11390 SUMMERLIN SQUARE DR
FORT MYERS BEACH FL
33931-5300
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-8880
  • Fax: 239-343-4213
Mailing address:
  • Phone: 239-343-8880
  • Fax: 239-343-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME163313
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License NumberME163313
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number0101265404
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License NumberMD473186
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101265404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: