Healthcare Provider Details

I. General information

NPI: 1013035336
Provider Name (Legal Business Name): SHOBHA BASU OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SUNRISE PLAZA DR STE 6
CLERMONT FL
34714-6202
US

IV. Provider business mailing address

2453 SOUTHLAWN LN
CLERMONT FL
34714-5451
US

V. Phone/Fax

Practice location:
  • Phone: 321-221-4629
  • Fax: 321-221-4629
Mailing address:
  • Phone: 862-823-9367
  • Fax: 862-823-9367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT6456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: