Provider Demographics
NPI:1295755502
Name:HOSSAIN, SHAHEENA (MD)
Entity type:Individual
Prefix:
First Name:SHAHEENA
Middle Name:
Last Name:HOSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8155
Mailing Address - Country:US
Mailing Address - Phone:630-653-6441
Mailing Address - Fax:630-653-8409
Practice Address - Street 1:1725 S NAPERVILLE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8155
Practice Address - Country:US
Practice Address - Phone:630-653-6441
Practice Address - Fax:630-653-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1094692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
05732028OtherBLUE CROSS BLUE SHIELD
IL209551OtherMEDICARE GROUP
IL036109469Medicaid
IL206744Medicare ID - Type UnspecifiedMEDICARE GROUP
IL209551OtherMEDICARE GROUP
IL036109469Medicaid