Provider Demographics
NPI:1467703538
Name:ELSEDOUDI, SHAIMA MAMDOUH (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SHAIMA
Middle Name:MAMDOUH
Last Name:ELSEDOUDI
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 1:6323 MEMORIAL HWY
Mailing Address - Street 2:BUILDING A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4509
Mailing Address - Country:US
Mailing Address - Phone:813-891-9474
Mailing Address - Fax:
Practice Address - Street 1:3848 FLATIRON LOOP UNIT 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7825
Practice Address - Country:US
Practice Address - Phone:813-648-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL871387746OtherLMHC