Provider Demographics
NPI:1205334638
Name:FATIMA, SAYYEDA HIBA (PA-C)
Entity type:Individual
Prefix:
First Name:SAYYEDA
Middle Name:HIBA
Last Name:FATIMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST STE 16-738
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-5924
Mailing Address - Fax:312-926-6134
Practice Address - Street 1:251 E HURON ST STE 16-738
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-5924
Practice Address - Fax:312-926-6134
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant