Provider Demographics
NPI:1356095954
Name:HASAN, ZAHIYAH T (NRMA, NRCPT)
Entity Type:Individual
Prefix:
First Name:ZAHIYAH
Middle Name:T
Last Name:HASAN
Suffix:
Gender:F
Credentials:NRMA, NRCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 SAINT ANDREWS RD # 26852712
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4220
Mailing Address - Country:US
Mailing Address - Phone:803-830-2048
Mailing Address - Fax:803-667-9673
Practice Address - Street 1:2712 MIDDLEBURG DR
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-830-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-05-30
Deactivation Date:2022-03-25
Deactivation Code:
Reactivation Date:2022-04-26
Provider Licenses
StateLicense IDTaxonomies
KS134339246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1356095954Medicaid