Provider Demographics
NPI:1073592036
Name:HANNA, SHIRLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLAZA NORTH
Mailing Address - Street 2:STE 310
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-3822
Mailing Address - Fax:516-663-4740
Practice Address - Street 1:222 STATION PLAZA NORTH
Practice Address - Street 2:STE 310
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-3822
Practice Address - Fax:516-663-4740
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS201111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477073OtherUNITED HEALTHCARE
5036625OtherAETNA
110159808OtherRAILROAD MEDICARE
1307781OtherFIRSTHEALTH
22N681OtherBC/BS
4539578005OtherCIGNA
P623635OtherOXFORD
NY01837558Medicaid
LC2442OtherHEALTHNET
74238OtherVYTRA
2599727OtherGHI
NY22N681Medicare ID - Type Unspecified