Provider Demographics
NPI:1093746489
Name:HASSAN, SAMEENA SHIREEN (MD)
Entity Type:Individual
Prefix:
First Name:SAMEENA
Middle Name:SHIREEN
Last Name:HASSAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMEENA
Other - Middle Name:HASSAN
Other - Last Name:EVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7283
Mailing Address - Fax:704-316-0508
Practice Address - Street 1:1315 EAST BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5975
Practice Address - Country:US
Practice Address - Phone:704-384-1866
Practice Address - Fax:704-384-1867
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13875OtherBCBS
NC5901118Medicaid
SCN96005Medicaid
NC5901118Medicaid