Healthcare Provider Details

I. General information

NPI: 1295416089
Provider Name (Legal Business Name): THE OSHODI FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 NE 125TH ST STE 317A
NORTH MIAMI FL
33161-5833
US

IV. Provider business mailing address

1065 NE 125TH ST STE 317A
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 305-636-2627
  • Fax:
Mailing address:
  • Phone: 305-636-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN EGBEAZIEN OSHODI
Title or Position: PRESIDENT
Credential: PHD
Phone: 305-636-2627