Provider Demographics
NPI:1568970374
Name:SHAKOOR-RIVERA, OSHETHA
Entity type:Individual
Prefix:
First Name:OSHETHA
Middle Name:
Last Name:SHAKOOR-RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9170 GLADES RD STE 159
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3904
Mailing Address - Country:US
Mailing Address - Phone:470-508-8800
Mailing Address - Fax:470-508-9800
Practice Address - Street 1:9170 GLADES RD STE 159
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3904
Practice Address - Country:US
Practice Address - Phone:470-508-8800
Practice Address - Fax:470-508-9800
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC12303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health