Healthcare Provider Details

I. General information

NPI: 1598247637
Provider Name (Legal Business Name): SHAHRAZAD EL SEBAEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 SOCIALVILLE FOSTER RD STE 101
MASON OH
45040-7353
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 220
LAKE MARY FL
32746-5035
US

V. Phone/Fax

Practice location:
  • Phone: 513-332-5779
  • Fax: 513-572-2192
Mailing address:
  • Phone: 833-288-4761
  • Fax: 407-588-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73788
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: