MEDICARE: DR. JOHN EGBEAZIEN OSHODI 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	103TC0700X	Clinical Psychologist	PY0004933	FL
2	103TF0200X	Forensic Psychologist	PY0004933	FL

General Provider Information

NPI Number	:	1881798932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EGBEAZIEN OSHODI PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 551874
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33055-0874
Country	:	US
Telephone Number	:	305-623-5979
Fax Number	:	305-623-0414

Provider Business Practice Location Address
First Line	:	1065 N.E. 125 STREET,
Second Line	:	SUITE 317A
City	:	MIAMI
State	:	FL
Zip	:	33161
Country	:	US
Telephone Number	:	305-623-5979
Fax Number	:	305-623-9414

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	03/13/2015

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