Healthcare Provider Details

I. General information

NPI: 1154304087
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF SOUTHWEST FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 BARKLEY CIR BUILDING A
FT MYERS FL
33907-7543
US

IV. Provider business mailing address

4790 BARKLEY CIR BUILDING A
FT MYERS FL
33907-7543
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-8882
  • Fax: 239-275-6304
Mailing address:
  • Phone: 239-275-8882
  • Fax: 239-275-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: NEEKAYTAN SHARMA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 239-275-8882