Provider Demographics
NPI:1346244829
Name:BESHAI, SUSANNA F (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:F
Last Name:BESHAI
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:13685 DOCTORS WAY
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4336
Practice Address - Country:US
Practice Address - Phone:239-275-6176
Practice Address - Fax:239-275-7245
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0084486208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2013500OtherCCN PROVIDER NUMBER
FL284771OtherAVMED PROVIDER NUMBER
00002211453 03OtherUHC PROVIDER NUMBER
FL11085OtherBCBS PROVIDER NUMBER
FL3739465OtherAETNA HMO PROVIDER #
FLME84486OtherMETCARE PROVIDER NUMBER
FL7457336OtherAETNA OTHER PROVIDER #
FL3677555-002OtherCIGNA PROVIDER NUMBER
FL284771OtherAVMED PROVIDER NUMBER
00002211453 03OtherUHC PROVIDER NUMBER