MEDICARE: FREYA HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306476049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREYA HEALTH LLC

Provider Business Mailing Address
First Line	:	9365 VIA MURANO CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5499
Country	:	US
Telephone Number	:	732-804-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 ESTERO BLVD STE 733
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4779
Country	:	US
Telephone Number	:	732-804-2014
Fax Number	:

Authorized Official
Title or Position	:	PA-C
Name	:	VANDANA PATEL
Credential	:
Telephone Number	:	732-804-2014

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	02/01/2020

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Directions to “FREYA HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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