MEDICARE: THE OSHODI FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TA0700X	Adult Development & Aging Psychologist
3	103TF0000X	Family Psychologist
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist
5	103TS0200X	School Psychologist
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295416089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OSHODI FOUNDATION

Provider Business Mailing Address
First Line	:	1065 NE 125TH ST STE 317A
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5833
Country	:	US
Telephone Number	:	305-636-3262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 NE 125TH ST STE 317A
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5833
Country	:	US
Telephone Number	:	305-636-2627
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN EGBEAZIEN OSHODI
Credential	:	PHD
Telephone Number	:	305-636-2627

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	05/14/2024

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Directions to “THE OSHODI FOUNDATION ” Practice Location

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