Healthcare Provider Details

I. General information

NPI: 1346945003
Provider Name (Legal Business Name): SUJIT ELIAS JOHNSTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12670 CREEKSIDE LN STE 202
FORT MYERS FL
33919-3370
US

IV. Provider business mailing address

12670 CREEKSIDE LN STE 202
FORT MYERS FL
33919-3370
US

V. Phone/Fax

Practice location:
  • Phone: 623-241-8682
  • Fax: 484-499-8459
Mailing address:
  • Phone: 623-241-8682
  • Fax: 484-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: