Healthcare Provider Details

I. General information

NPI: 1154884518
Provider Name (Legal Business Name): NATALI GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 PINE RIDGE RD STE 201
NAPLES FL
34109-3938
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-4270
  • Fax: 239-254-4271
Mailing address:
  • Phone: 239-254-4270
  • Fax: 239-254-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME179531
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number341781
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: