Provider Demographics
NPI:1750660841
Name:SUTRIASA, SHAKTI (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHAKTI
Middle Name:
Last Name:SUTRIASA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4467
Mailing Address - Street 2:
Mailing Address - City:ROLLINGBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98061-0467
Mailing Address - Country:US
Mailing Address - Phone:206-486-4338
Mailing Address - Fax:
Practice Address - Street 1:1850 43RD AVE
Practice Address - Street 2:C-11
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0504
Practice Address - Country:US
Practice Address - Phone:772-321-2291
Practice Address - Fax:772-617-2179
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 115791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical