Healthcare Provider Details

I. General information

NPI: 1518156959
Provider Name (Legal Business Name): VENKATA KRISHNA JAYANTH PARSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14543 GLOBAL PKWY STE 1102ND
FORT MYERS FL
33913-7225
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 239-264-7026
  • Fax:
Mailing address:
  • Phone: 855-963-2100
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME137254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: