Provider Demographics
NPI:1629962519
Name:GUSTAVE, SHTELY SABUNA (ITDS)
Entity type:Individual
Prefix:MRS
First Name:SHTELY
Middle Name:SABUNA
Last Name:GUSTAVE
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 1ST LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4255
Mailing Address - Country:US
Mailing Address - Phone:561-729-1824
Mailing Address - Fax:
Practice Address - Street 1:101 1ST LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4255
Practice Address - Country:US
Practice Address - Phone:561-729-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist