Provider Demographics
NPI:1881798932
Name:OSHODI, JOHN EGBEAZIEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EGBEAZIEN
Last Name:OSHODI
Suffix:
Gender:M
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:PO BOX 551874
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-0874
Mailing Address - Country:US
Mailing Address - Phone:305-623-5979
Mailing Address - Fax:305-623-0414
Practice Address - Street 1:1065 N.E. 125 STREET,
Practice Address - Street 2:SUITE 317A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161
Practice Address - Country:US
Practice Address - Phone:305-623-5979
Practice Address - Fax:305-623-9414
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004933103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650420803Medicare UPIN