Provider Demographics
NPI:1629188446
Name:MOTTA, SHEREE DENISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHEREE
Middle Name:DENISE
Last Name:MOTTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 E OAKLAND PARK BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1617
Mailing Address - Country:US
Mailing Address - Phone:954-564-7055
Mailing Address - Fax:954-202-3453
Practice Address - Street 1:2601 E OAKLAND PARK BLVD STE 600
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1617
Practice Address - Country:US
Practice Address - Phone:954-564-7055
Practice Address - Fax:954-202-3453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73935Medicare ID - Type Unspecified