Healthcare Provider Details

I. General information

NPI: 1326950346
Provider Name (Legal Business Name): LOVE SHIRLEY DANAELLE SAINT JUSTE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 W MCNAB RD APT D310
POMPANO BEACH FL
33069-6518
US

IV. Provider business mailing address

4015 W MCNAB RD APT D310
POMPANO BEACH FL
33069-6518
US

V. Phone/Fax

Practice location:
  • Phone: 754-235-4343
  • Fax:
Mailing address:
  • Phone: 754-235-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number559642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: