Provider Demographics
NPI:1003144197
Name:HASAN SHAHAB, M.D., P.A
Entity Type:Organization
Organization Name:HASAN SHAHAB, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-420-7952
Mailing Address - Street 1:PO BOX 691326
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-1326
Mailing Address - Country:US
Mailing Address - Phone:407-420-7952
Mailing Address - Fax:407-420-7953
Practice Address - Street 1:10960 DYLAN LOREN CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4439
Practice Address - Country:US
Practice Address - Phone:407-420-7952
Practice Address - Fax:407-420-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98747207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty