Provider Demographics
NPI:1932107398
Name:SCHLEIDER, NANCY R (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:SCHLEIDER
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 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:239-931-7382
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:STE 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070011738OtherRAILROAD PROVIDER NUMBER
FL36409YMedicare PIN
FL070011738OtherRAILROAD PROVIDER NUMBER