Provider Demographics
NPI:1275756603
Name:KANACHERIL, SHEEJA A (DO)
Entity Type:Individual
Prefix:
First Name:SHEEJA
Middle Name:A
Last Name:KANACHERIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 LEE BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4893
Mailing Address - Country:US
Mailing Address - Phone:239-368-0241
Mailing Address - Fax:239-368-0398
Practice Address - Street 1:1530 LEE BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4893
Practice Address - Country:US
Practice Address - Phone:239-368-0241
Practice Address - Fax:239-368-0398
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278616800Medicaid
FL46017OtherBLUE CROSS
FL325319OtherAETNA
FL390683OtherWELLCARE
FL325319OtherAMERIGROUP
FL278616800Medicaid