Provider Demographics
NPI:1881563229
Name:SHARAFI, MAHTA
Entity type:Individual
Prefix:MISS
First Name:MAHTA
Middle Name:
Last Name:SHARAFI
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 1:5535 CANOGA AVE APT 303
Mailing Address - Street 2:#303
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6636
Mailing Address - Country:US
Mailing Address - Phone:310-460-8895
Mailing Address - Fax:
Practice Address - Street 1:5535 CANOGA AVE APT 303
Practice Address - Street 2:#303
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6636
Practice Address - Country:US
Practice Address - Phone:310-460-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95037019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner