Healthcare Provider Details

I. General information

NPI: 1750173639
Provider Name (Legal Business Name): TIBA CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 SW 74TH CT FL 1
MIAMI FL
33155-4412
US

IV. Provider business mailing address

4929 SW 74TH CT FL 1
MIAMI FL
33155-4412
US

V. Phone/Fax

Practice location:
  • Phone: 617-615-5547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMED ELSHAFEI
Title or Position: MGR
Credential: MD
Phone: 617-615-5547