MEDICARE: DR. SHEBA PAIVANDY KATZ PH.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY8046	FL
2	103TC1900X	Counseling Psychologist	PY8046	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790065043	OTHER	FL	ORGANIZATION NPI
2	452038681	OTHER	FL	TAX ID

General Provider Information

NPI Number	:	1720393705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEBA PAIVANDY KATZ PH.D.

Provider Business Mailing Address
First Line	:	12791 WORLD PLAZA LN
Second Line	:	BLDG 89
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3989
Country	:	US
Telephone Number	:	239-247-1756
Fax Number	:	239-690-2438

Provider Business Practice Location Address
First Line	:	12791 WORLD PLAZA LN
Second Line	:	BLDG. #89
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3989
Country	:	US
Telephone Number	:	239-247-1756
Fax Number	:	239-690-2438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	09/16/2016

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