MEDICARE: DR. MARK SHATS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PY8156	FL
2	103TC0700X	Clinical Psychologist	PY8156	FL
3	103TC2200X	Clinical Child & Adolescent Psychologist	PY8156	FL
4	103TF0000X	Family Psychologist	PY8156	FL
5	103TF0200X	Forensic Psychologist	PY8156	FL
6	103TP2701X	Group Psychotherapy Psychologist	PY8156	FL

General Provider Information

NPI Number	:	1700170446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SHATS PSYD

Provider Business Mailing Address
First Line	:	4219 ANNE CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-6626
Country	:	US
Telephone Number	:	415-717-8146
Fax Number	:

Provider Business Practice Location Address
First Line	:	4254 LENNOX DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-6721
Country	:	US
Telephone Number	:	415-717-8146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2011
Last Update Date	:	05/29/2011

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