MEDICARE: AMITHA BENA OMONUWA PA-C

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	363A00000X	Physician Assistant	PA9109689	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	551847	OTHER	GA	WELLCARE
5	01348305	OTHER	GA	AMERIGROUP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821310426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMITHA BENA OMONUWA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9960
Fax Number	:	239-424-4006

Provider Business Practice Location Address
First Line	:	708 DEL PRADO BLVD S STE 3
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2676
Country	:	US
Telephone Number	:	239-343-9960
Fax Number	:	239-424-4006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	03/29/2021

Similar Medicare Providers

1942421110 — KENNETH ROBERT LEYMEISTER PA-C
Practice Location Address:

708 DEL PRADO BLVD S STE 3
CAPE CORAL, FL
33990-2676

Practice Phone: 239-343-9960
Practice Fax: 239-424-4006

1801899786 — DR. THOMAS (TOMAS) CARRASQUILLO JR. M.D.
Practice Location Address:

708 S. DEL PRADO BLVD , SUITE 1
CAPE CORAL, FL
33990-2676

Practice Phone: 239-574-7454
Practice Fax: 239-574-9439

1124029012 — SALVATORE LACAGNINA D.O.
Practice Location Address:

708 DEL PRADO BLVD S STE 2
CAPE CORAL, FL
33990-2676

Practice Phone: 239-424-2120
Practice Fax: 239-424-4017

1114916939 — CAROL L GRUVER MD
Practice Location Address:

708 DEL PRADO BLVD S STE 7
CAPE CORAL, FL
33990-2676

Practice Phone: 239-424-3660
Practice Fax: 239-343-4133

1578887477 — JOSEPH ROCCO BASI ARNP
Practice Location Address:

708 DEL PRADO BLVD S STE 7
CAPE CORAL, FL
33990-2676

Practice Phone: 239-424-3660
Practice Fax: 239-343-4133

1043523186 — DR. PREETH KADA SUNDARAN
Practice Location Address:

708 DEL PRADO BLVD S STE 7
CAPE CORAL, FL
33990-2676

Practice Phone: 239-424-3660
Practice Fax: 239-424-3663

Directions to “ AMITHA BENA OMONUWA PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.