Healthcare Provider Details

I. General information

NPI: 1407506041
Provider Name (Legal Business Name): SYDNEY LEE NOTERMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 BAYSHORE RD STE 120
PORT CHARLOTTE FL
33980-2005
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-4920
  • Fax: 239-468-7935
Mailing address:
  • Phone: 941-235-4920
  • Fax: 239-468-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79946
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME182143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: