Healthcare Provider Details

I. General information

NPI: 1932887155
Provider Name (Legal Business Name): MIRAF SHEHATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 VENTURA BLVD STE 1105
SHERMAN OAKS CA
91403-3510
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE STE 220
MONROVIA CA
91016-5239
US

V. Phone/Fax

Practice location:
  • Phone: 747-298-3480
  • Fax:
Mailing address:
  • Phone: 310-913-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: