NPIMap

Organization Active NPI

Pooja Shastri, Psy.D., P.a.

  • Clinical Psychologist
  • Fort Myers, FL
National Provider Identifier
1891334157
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
POOJA SHASTRI, PSY.D., P.A.
Practice address
13430 Parker Commons Blvd Ste 101
Fort Myers, FL 33912-1812
Phone
(239) 561-9955
Fax
(239) 561-9779
NPI assigned
Jan 3, 2020
Last updated
Jan 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Pooja Shastri, PSY.D.NPI 1932656899
Title
President
Phone
(773) 677-2170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

13430 Parker Commons Blvd Ste 101
Fort Myers, FL 33912-1812

Mailing address

3606 Treasure Cove Cir
Naples, FL 34114-3983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200403000642 FL Part B Supplier - Clinic/Group Practice 4082043534 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1891334157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 TREASURE COVE CIR",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341143983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13430 PARKER COMMONS BLVD STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339121812",
            "telephone_number": "239-561-9955",
            "fax_number": "239-561-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POOJA SHASTRI, PSY.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "SHASTRI",
        "authorized_official_first_name": "POOJA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-677-2170",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.