Provider Demographics
NPI:1144906595
Name:MOFFETT JOSEPH, SHATAVIA
Entity type:Individual
Prefix:
First Name:SHATAVIA
Middle Name:
Last Name:MOFFETT JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 BISCAYNE BLVD # 2071
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5013
Mailing Address - Country:US
Mailing Address - Phone:786-231-7511
Mailing Address - Fax:
Practice Address - Street 1:299 NW 40TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127
Practice Address - Country:US
Practice Address - Phone:786-231-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW209631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical