Provider Demographics
NPI:1083810493
Name:LAVASANI, LEELA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEELA
Middle Name:S
Last Name:LAVASANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 PINE RIDGE RD UNIT 450
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3928
Mailing Address - Country:US
Mailing Address - Phone:239-514-2225
Mailing Address - Fax:239-514-2280
Practice Address - Street 1:6376 PINE RIDGE RD UNIT 450
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3928
Practice Address - Country:US
Practice Address - Phone:239-514-2225
Practice Address - Fax:239-514-2280
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188403207Y00000X
FLME109866207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004121200Medicaid