Healthcare Provider Details

I. General information

NPI: 1952619348
Provider Name (Legal Business Name): SUNITHA GOWDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUNITHA V MUDALAGIRI GOWDA

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BETH STACEY BLVD UNIT 110
LEHIGH ACRES FL
33936-6074
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: 239-343-4264
Mailing address:
  • Phone: 239-343-9888
  • Fax: 239-343-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME180932
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01083183A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: