Provider Demographics
NPI:1598451957
Name:WASEEM, HANIYA (MD)
Entity Type:Individual
Prefix:
First Name:HANIYA
Middle Name:
Last Name:WASEEM
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 1:13601 BRUCE B DOWN BLVD SUITE 321
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613
Mailing Address - Country:US
Mailing Address - Phone:863-971-6000
Mailing Address - Fax:
Practice Address - Street 1:13601 BRUCE B DOWN BLVD SUITE 321
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:863-971-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2024-01-03
Deactivation Date:2023-11-22
Deactivation Code:
Reactivation Date:2024-01-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN37821390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program