Healthcare Provider Details

I. General information

NPI: 1891334157
Provider Name (Legal Business Name): POOJA SHASTRI, PSY.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 PARKER COMMONS BLVD STE 101
FORT MYERS FL
33912-1812
US

IV. Provider business mailing address

3606 TREASURE COVE CIR
NAPLES FL
34114-3983
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-9955
  • Fax: 239-561-9779
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. POOJA SHASTRI
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 773-677-2170