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General NPI Number Information
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NPI Number | 1932656899
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Entity Type | Individual
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Provider Name | POOJA SHASTRI PSY.D
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Gender | Female
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 13430 PARKER COMMONS BLVD STE 101
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City | FORT MYERS
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State | FL
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Zip | 33912-1812
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Country | US
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Telephone | 239-561-9955
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Fax | 239-561-9779
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Provider Business Mailing Address
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Address Line | 3606 TREASURE COVE CIR
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City | NAPLES
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State | FL
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Zip | 34114-3983
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 9643
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | PY 9643
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License Number State | FL
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