Healthcare Provider Details

I. General information

NPI: 1508865924
Provider Name (Legal Business Name): BRETT E STANALAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GOODLETTE RD N SUITE 200
NAPLES FL
34102-5474
US

IV. Provider business mailing address

1000 GOODLETTE RD N SUITE 200
NAPLES FL
34102-5474
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-6200
  • Fax: 239-434-5741
Mailing address:
  • Phone: 239-434-6200
  • Fax: 239-434-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0062874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: