1659381614 NPI number — ADVANCED GASTROENTEROLOGY OF NAPLES, LLC

Table of content: DANIKA BRENNEMAN MA SLP (NPI 1275202319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659381614 NPI number — ADVANCED GASTROENTEROLOGY OF NAPLES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED GASTROENTEROLOGY OF NAPLES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659381614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4760 TAMIAMI TRL N
Provider Second Line Business Mailing Address:
STE 27
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34103-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-593-9599
Provider Business Mailing Address Fax Number:
239-593-4099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4760 TAMIAMI TRL N
Provider Second Line Business Practice Location Address:
STE 27
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-593-9599
Provider Business Practice Location Address Fax Number:
239-593-4099
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NANAVATI
Authorized Official First Name:
SHARDUL
Authorized Official Middle Name:
ASHWIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-593-9599

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME92248 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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