Provider Demographics
NPI:1740228378
Name:ESMAILI, SINA (MD)
Entity Type:Individual
Prefix:
First Name:SINA
Middle Name:
Last Name:ESMAILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S COLLIER BLVD
Mailing Address - Street 2:APT 202
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6021
Mailing Address - Country:US
Mailing Address - Phone:239-389-0434
Mailing Address - Fax:
Practice Address - Street 1:6875 ESTERO BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-4608
Practice Address - Country:US
Practice Address - Phone:239-463-5741
Practice Address - Fax:239-463-5578
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21262Medicare UPIN
FL11143YMedicare ID - Type UnspecifiedMEDICARE #