Provider Demographics
NPI:1811952302
Name:SASSANI, RAMIN (DO)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:SASSANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RAMIN
Other - Middle Name:
Other - Last Name:SASSANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:13861 PLANTATION RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4342
Mailing Address - Country:US
Mailing Address - Phone:239-225-1306
Mailing Address - Fax:239-768-1313
Practice Address - Street 1:13861 PLANTATION RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4342
Practice Address - Country:US
Practice Address - Phone:239-225-1306
Practice Address - Fax:239-768-1313
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009896L207R00000X
FLOS11787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017648240004Medicaid
H01803Medicare UPIN
030436Medicare ID - Type Unspecified