Provider Demographics
NPI:1134263551
Name:MBIZA, SARAH TISTSI (PHD, OTR/L, CRC)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:TISTSI
Last Name:MBIZA
Suffix:
Gender:F
Credentials:PHD, OTR/L, CRC
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:TSITSI
Other - Last Name:MASIYANDIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:8958 W STATE ROAD 84 # 261
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4457
Mailing Address - Country:US
Mailing Address - Phone:954-271-2730
Mailing Address - Fax:
Practice Address - Street 1:12941 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2295
Practice Address - Country:US
Practice Address - Phone:954-271-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-8092225X00000X
FLPY10089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888716100Medicaid