Provider Demographics
NPI:1720393705
Name:KATZ, SHEBA PAIVANDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEBA
Middle Name:PAIVANDY
Last Name:KATZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12791 WORLD PLAZA LN
Mailing Address - Street 2:BLDG 89
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3989
Mailing Address - Country:US
Mailing Address - Phone:239-247-1756
Mailing Address - Fax:239-690-2438
Practice Address - Street 1:12791 WORLD PLAZA LN
Practice Address - Street 2:BLDG. #89
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3989
Practice Address - Country:US
Practice Address - Phone:239-247-1756
Practice Address - Fax:239-690-2438
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8046103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1790065043OtherORGANIZATION NPI
FL452038681OtherTAX ID