Provider Demographics
NPI:1851822704
Name:PRADO-WRIGHT, GISELLE (MD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:PRADO-WRIGHT
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:PO BOX 1947
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1947
Mailing Address - Country:US
Mailing Address - Phone:786-325-8897
Mailing Address - Fax:
Practice Address - Street 1:13730 CYPRESS TERRACE CIR STE 401
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8826
Practice Address - Country:US
Practice Address - Phone:866-373-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141083208D00000X
NY295495-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice