MEDICARE: MS. SHAIMA MAMDOUH ELSEDOUDI LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH13805	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	871387746	OTHER	FL	LMHC

General Provider Information

NPI Number	:	1467703538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAIMA MAMDOUH ELSEDOUDI LMHC

Provider Business Mailing Address
First Line	:	6323 MEMORIAL HWY
Second Line	:	BUILDING A
City	:	TAMPA
State	:	FL
Zip	:	33615-4509
Country	:	US
Telephone Number	:	813-891-9474
Fax Number	:

Provider Business Practice Location Address
First Line	:	3848 FLATIRON LOOP UNIT 102
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7825
Country	:	US
Telephone Number	:	813-648-7220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	05/31/2022

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