Provider Demographics
NPI:1962528885
Name:SAMUEL, ANEETA P (M D)
Entity type:Individual
Prefix:
First Name:ANEETA
Middle Name:P
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13607 PINE VILLA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1617
Mailing Address - Country:US
Mailing Address - Phone:239-424-3123
Mailing Address - Fax:239-424-4041
Practice Address - Street 1:13607 PINE VILLA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1617
Practice Address - Country:US
Practice Address - Phone:239-424-3123
Practice Address - Fax:239-424-4041
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00854689OtherRAILROAD
FL279345800Medicaid
FLAF355XMedicare PIN