Provider Demographics
NPI:1922674100
Name:HATHAN, SHIMAA
Entity Type:Individual
Prefix:
First Name:SHIMAA
Middle Name:
Last Name:HATHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # D2-27
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0415
Mailing Address - Country:US
Mailing Address - Phone:252-273-7957
Mailing Address - Fax:352-846-1643
Practice Address - Street 1:1600 SW ARCHER RD # D2-27
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0415
Practice Address - Country:US
Practice Address - Phone:252-273-7957
Practice Address - Fax:352-846-1643
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist