Basic Information
| Provider Information | |||||||||
| NPI: | 1154614998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAHINFAR | ||||||||
| FirstName: | SHOLEH | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 IRVINE AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926603109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408764855 | ||||||||
| FaxNumber: | 9492509485 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 IRVINE AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926603109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408764855 | ||||||||
| FaxNumber: | 9492509485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 06545 | MD | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 18481 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.