Provider Demographics
NPI:1225597933
Name:SHALABY, AMIRA H
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:H
Last Name:SHALABY
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:PO BOX 5348
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32793-5348
Mailing Address - Country:US
Mailing Address - Phone:407-867-1033
Mailing Address - Fax:
Practice Address - Street 1:4063 N GOLDENROD RD STE 210
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8900
Practice Address - Country:US
Practice Address - Phone:407-624-4002
Practice Address - Fax:866-920-4210
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician