Provider Demographics
NPI:1407301690
Name:HAJJA, SHATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHATHA
Middle Name:
Last Name:HAJJA
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 1:10460 QUEENS BLVD APT 2S
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7351
Mailing Address - Country:US
Mailing Address - Phone:504-435-0852
Mailing Address - Fax:
Practice Address - Street 1:821 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3453
Practice Address - Country:US
Practice Address - Phone:866-682-4842
Practice Address - Fax:209-826-0952
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159695208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics