Healthcare Provider Details

I. General information

NPI: 1639522063
Provider Name (Legal Business Name): RACHEL SEWNARINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13782 PLANTATION RD UNIT 201
FORT MYERS FL
33912-4462
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1100
  • Fax: 239-468-7916
Mailing address:
  • Phone: 239-343-1100
  • Fax: 239-468-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.149705
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME165302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: