Healthcare Provider Details

I. General information

NPI: 1497672901
Provider Name (Legal Business Name): GEORGIA TONI SITARAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 W PALMETTO PARK RD STE 106
BOCA RATON FL
33432-3760
US

IV. Provider business mailing address

5481 OLD MYSTIC CT
JUPITER FL
33458-3400
US

V. Phone/Fax

Practice location:
  • Phone: 561-961-9077
  • Fax:
Mailing address:
  • Phone: 561-628-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: