Provider Demographics
NPI:1700503802
Name:SHELLY KHALDI, PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SHELLY KHALDI, PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALDI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-992-0038
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:
Practice Address - Street 1:1304 SOUTH DESOTO AVENUE SUITE 204
Practice Address - Street 2:2144 SEVEN SPRINGS BOULEVARD
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-992-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty