Healthcare Provider Details

I. General information

NPI: 1972573780
Provider Name (Legal Business Name): SUSHIL KUMAR MEHROTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16715 ENCLAVE CIR
NAPLES FL
34110-3502
US

IV. Provider business mailing address

16715 ENCLAVE CIR
NAPLES FL
34110-3502
US

V. Phone/Fax

Practice location:
  • Phone: 304-280-6389
  • Fax:
Mailing address:
  • Phone: 304-280-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME153159
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number13159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: