Provider Demographics
NPI:1881378990
Name:KALANTARI, SHEIDA (MHS)
Entity type:Individual
Prefix:MS
First Name:SHEIDA
Middle Name:
Last Name:KALANTARI
Suffix:
Gender:F
Credentials:MHS
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 50695
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0695
Mailing Address - Country:US
Mailing Address - Phone:949-664-4271
Mailing Address - Fax:
Practice Address - Street 1:3540 HOWARD WAY STE 150
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1496
Practice Address - Country:US
Practice Address - Phone:949-646-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist