Healthcare Provider Details

I. General information

NPI: 1629235247
Provider Name (Legal Business Name): FADY H GEHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NEBRASKA AVE SUITE 9
FORT PIERCE FL
34950-4837
US

IV. Provider business mailing address

31 HARBOUR ISLE DR W APT. 203
HUTCHINSON ISLAND FL
34949-2783
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-4757
  • Fax: 772-466-0832
Mailing address:
  • Phone: 772-465-4757
  • Fax: 772-466-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME128991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: