Provider Demographics
NPI:1518515386
Name:SHALBAFIAN, MAHTAB MICHELLE
Entity type:Individual
Prefix:
First Name:MAHTAB
Middle Name:MICHELLE
Last Name:SHALBAFIAN
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 1:735 CUMBERLAND TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1233
Mailing Address - Country:US
Mailing Address - Phone:954-478-6302
Mailing Address - Fax:
Practice Address - Street 1:650 NE 22ND TER STE 206
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4710
Practice Address - Country:US
Practice Address - Phone:786-601-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist