Provider Demographics
NPI:1215571849
Name:ZEIDAN, SOUHEIL HASSAN SR
Entity Type:Individual
Prefix:MR
First Name:SOUHEIL
Middle Name:HASSAN
Last Name:ZEIDAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 38TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-4356
Mailing Address - Country:US
Mailing Address - Phone:239-218-2299
Mailing Address - Fax:
Practice Address - Street 1:3419 38TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-4356
Practice Address - Country:US
Practice Address - Phone:239-218-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2392192299Medicaid