Provider Demographics
NPI:1972117109
Name:MOGILISHETTY PLLC
Entity Type:Organization
Organization Name:MOGILISHETTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-939-0999
Mailing Address - Street 1:3400 LEE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1309
Mailing Address - Country:US
Mailing Address - Phone:239-939-0999
Mailing Address - Fax:239-939-1070
Practice Address - Street 1:3400 LEE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1309
Practice Address - Country:US
Practice Address - Phone:239-939-0999
Practice Address - Fax:239-939-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty