Individual
DIVYA PANNEERSELVAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
316 DEL PRADO BLVD S, CAPE CORAL, FL 33990-1710
(239) 226-4592
(239) 458-0623
Mailing address
PO BOX 1357, FORT MYERS, FL 33902-1357
(239) 278-3600
(239) 278-3857
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME123954
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014953400
—
FL
Enumeration date
05/22/2014
Last updated
07/05/2016
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