Provider Demographics
NPI:1104024587
Name:KHALDI, SHELLY RAE (LMHC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAE
Last Name:KHALDI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 PICCARD LOOP
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3206
Mailing Address - Country:US
Mailing Address - Phone:727-992-0038
Mailing Address - Fax:773-692-3918
Practice Address - Street 1:300 S HYDE PARK AVE STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4123
Practice Address - Country:US
Practice Address - Phone:727-992-0038
Practice Address - Fax:877-369-2391
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9011OtherDOH LMHC