Provider Demographics
NPI:1003130287
Name:HASAN, SHAMIM A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAMIM
Middle Name:A
Last Name:HASAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAMIM
Other - Middle Name:A
Other - Last Name:ALIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11317 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 600.
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11317 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 600.
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4435
Practice Address - Country:US
Practice Address - Phone:407-482-7788
Practice Address - Fax:407-482-8698
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant