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General NPI Number Information
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NPI Number | 1043675853
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Entity Type | Individual
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Provider Name | SHEA PUCCI M.S
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Gender | Female
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 4200 N UNIVERSITY DR
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City | SUNRISE
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State | FL
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Zip | 33351-6210
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Country | US
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Telephone | 954-647-6483
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Fax |
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Provider Business Mailing Address
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Address Line | 10424 SW 23RD CT
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City | DAVIE
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State | FL
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Zip | 33324-7622
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Country | US
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Telephone | 954-632-4408
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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