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General NPI Number Information
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NPI Number | 1205782166
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Entity Type | Organization
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Legal Business Name | SHAMISO WELLNESS INSTITUTE
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 1607 VILLAGE SQUARE BLVD STE 5
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City | TALLAHASSEE
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State | FL
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Zip | 32309-2772
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Country | US
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Telephone | 850-294-6906
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Fax | 850-807-5214
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Provider Business Mailing Address
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Address Line | 145 NORTHCUTT TER
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City | TALLAHASSEE
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State | FL
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Zip | 32317-7216
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Country | US
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Telephone | 850-294-6906
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Fax | 850-807-5214
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. SARAH TISTSI MBIZA
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Credential | PHD
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Telephone | 850-294-6906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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