Provider Demographics
NPI:1629191804
Name:NANCY R SCHLEIDER MD PA
Entity Type:Organization
Organization Name:NANCY R SCHLEIDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-768-2057
Mailing Address - Street 1:PO BOX 7518
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7518
Mailing Address - Country:US
Mailing Address - Phone:239-931-7262
Mailing Address - Fax:239-931-7397
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:SUITE 420
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4327
Practice Address - Country:US
Practice Address - Phone:239-768-2057
Practice Address - Fax:239-768-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS8673OtherRAILROAD MEDICARE
FLDS8673OtherRAILROAD MEDICARE
FLD54512Medicare UPIN