Provider Demographics
NPI:1154614998
Name:SHAHINFAR, SHOLEH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHOLEH
Middle Name:
Last Name:SHAHINFAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19782 MACARTHUR BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2417
Mailing Address - Country:US
Mailing Address - Phone:949-929-9248
Mailing Address - Fax:949-250-9485
Practice Address - Street 1:19782 MACARTHUR BLVD STE 310
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2417
Practice Address - Country:US
Practice Address - Phone:949-929-9248
Practice Address - Fax:949-250-9485
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06545235Z00000X
CA18481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist