Healthcare Provider Details

I. General information

NPI: 1134515687
Provider Name (Legal Business Name): AHMED MOHAMED MOHSEN ELBEDEWY MD, FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 PINE RIDGE RD STE 101
NAPLES FL
34109-3937
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-5920
  • Fax: 239-254-5921
Mailing address:
  • Phone: 239-254-5920
  • Fax: 239-254-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number294636-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME146403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: