Provider Demographics
NPI:1760442057
Name:GESLANI, RANDOLPH S (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:S
Last Name:GESLANI
Suffix:
Gender:M
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 51679
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33994-1679
Mailing Address - Country:US
Mailing Address - Phone:239-368-7260
Mailing Address - Fax:239-694-5953
Practice Address - Street 1:228 PLAZA DR
Practice Address - Street 2:SUITE E
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6054
Practice Address - Country:US
Practice Address - Phone:239-368-7260
Practice Address - Fax:239-694-5953
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038996000Medicaid
FL038996000Medicaid