Provider Demographics
NPI:1255004545
Name:SHEHATA, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:SHEHATA
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 1:8802 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5606
Mailing Address - Country:US
Mailing Address - Phone:347-357-0005
Mailing Address - Fax:
Practice Address - Street 1:9508 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7325
Practice Address - Country:US
Practice Address - Phone:347-357-0005
Practice Address - Fax:718-333-5206
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist