Provider Demographics
NPI:1063294700
Name:SHALABI, CHELSEA IRENE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:IRENE
Last Name:SHALABI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BLACKBIRD ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93523-2615
Mailing Address - Country:US
Mailing Address - Phone:256-651-7310
Mailing Address - Fax:
Practice Address - Street 1:647 W AVENUE Q STE C
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3893
Practice Address - Country:US
Practice Address - Phone:661-949-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52848225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant