Provider Demographics
NPI:1194112201
Name:CHESONI, SANDRA AHERWA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:AHERWA
Last Name:CHESONI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9633
Mailing Address - Fax:239-343-4015
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 2220
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8129
Practice Address - Country:US
Practice Address - Phone:239-343-9633
Practice Address - Fax:239-343-4015
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146154207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107081400Medicaid