Provider Demographics
NPI:1134320500
Name:SHAHAB, HASAN (MD)
Entity type:Individual
Prefix:
First Name:HASAN
Middle Name:
Last Name:SHAHAB
Suffix:
Gender:M
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:PO BOX 691326
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-1326
Mailing Address - Country:US
Mailing Address - Phone:407-420-7952
Mailing Address - Fax:407-420-7953
Practice Address - Street 1:10960 DYLAN LOREN CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4439
Practice Address - Country:US
Practice Address - Phone:407-420-7952
Practice Address - Fax:407-420-7953
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98747207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ841AMedicare PIN