Healthcare Provider Details

I. General information

NPI: 1396436531
Provider Name (Legal Business Name): GEETA IYER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 S CLEVELAND AVE
FORT MYERS FL
33907-1317
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9888
  • Fax: 239-343-4260
Mailing address:
  • Phone: 239-343-9888
  • Fax: 239-343-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS23453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: