Provider Demographics
NPI:1881629129
Name:SHENOY, GANESH (MD)
Entity Type:Individual
Prefix:
First Name:GANESH
Middle Name:
Last Name:SHENOY
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 1:14181 S TAMIAMI TRL STE 120A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1985
Mailing Address - Country:US
Mailing Address - Phone:239-303-2820
Mailing Address - Fax:239-303-2511
Practice Address - Street 1:14181 S TAMIAMI TRL STE 120A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1985
Practice Address - Country:US
Practice Address - Phone:239-303-2820
Practice Address - Fax:239-303-2511
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85488207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29034OtherBCBSFL
G84882Medicare UPIN
FL29034YMedicare PIN
FLP00262236Medicare PIN