Provider Demographics
NPI:1720025968
Name:HANNA, SHAHIRA (MD)
Entity Type:Individual
Prefix:
First Name:SHAHIRA
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAHIRA
Other - Middle Name:H
Other - Last Name:KENEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4577 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2516
Mailing Address - Country:US
Mailing Address - Phone:228-388-4816
Mailing Address - Fax:228-388-5906
Practice Address - Street 1:2781 C T SWITZER SR DRIVE
Practice Address - Street 2:STE 302
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4535
Practice Address - Country:US
Practice Address - Phone:228-388-4816
Practice Address - Fax:228-388-5906
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14216207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114485Medicaid
MS512I160034Medicare PIN
E12909Medicare UPIN
MS00114485Medicaid