Provider Demographics
NPI:1265247514
Name:GROSS, SHIFRA LEAH (PSYD)
Entity type:Individual
Prefix:
First Name:SHIFRA
Middle Name:LEAH
Last Name:GROSS
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 1:210 JUPITER LAKES BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7188
Mailing Address - Country:US
Mailing Address - Phone:561-870-0411
Mailing Address - Fax:
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 201
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7188
Practice Address - Country:US
Practice Address - Phone:561-870-0411
Practice Address - Fax:561-972-4036
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist