Provider Demographics
NPI:1891334157
Name:POOJA SHASTRI, PSY.D., P.A.
Entity Type:Organization
Organization Name:POOJA SHASTRI, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POOJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASTRI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-677-2170
Mailing Address - Street 1:3606 TREASURE COVE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-3983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13430 PARKER COMMONS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1812
Practice Address - Country:US
Practice Address - Phone:239-561-9955
Practice Address - Fax:239-561-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty