Individual
SYEDA SUMARA TARANUM BASITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9800 S HEALTHPARK DR STE 110, FORT MYERS, FL 33908-3630
(239) 343-6050
(239) 343-6883
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-6050
(239) 343-6883
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME140503
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103415600
—
FL
01
—
2C0AX
BCBS
FL
Enumeration date
03/23/2017
Last updated
11/18/2021
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