Provider Demographics
NPI:1700837614
Name:FATHALLAH-SHAYKH, HASSAN
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:FATHALLAH-SHAYKH
Suffix:
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 1:619 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL290672084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL105727Medicaid
BF3638775OtherFED DRUG ENFORCEMENT AGEN
ALP00728686OtherRAILROAD MEDICARE
AL105725Medicaid
MS00433756Medicaid
IL036075653Medicaid
AL051593944OtherBCBS
IL336038993OtherIL DEPT OF FI PROF REG
AL051593942OtherBCBS
AL105724Medicaid
AL051593943OtherBCBS
AL510I130029Medicare PIN
ALP00728686OtherRAILROAD MEDICARE
AL051593943OtherBCBS