Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY70008 | FL |
Y | 103T00000X | Psychologist | PY70008 | FL |
NPI | 1013926898 |
---|---|
Provider Name | Kim Shimoda |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102622500 | (05) | FL |