Healthcare Provider Details

I. General information

NPI: 1528450632
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF SWFL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 GOODLETTE RD N SUITE 100
NAPLES FL
34102-5406
US

IV. Provider business mailing address

1008 GOODLETTE RD N SUITE 100
NAPLES FL
34102-5406
US

V. Phone/Fax

Practice location:
  • Phone: 239-325-2086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: REISHA BROWN
Title or Position: PHYSICIAN
Credential: MD
Phone: 239-404-3211