Provider Demographics
NPI:1376384867
Name:HASAN, WALED KHALED SR
Entity type:Individual
Prefix:MR
First Name:WALED
Middle Name:KHALED
Last Name:HASAN
Suffix:SR
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 1:5884 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-6205
Mailing Address - Country:US
Mailing Address - Phone:513-239-9666
Mailing Address - Fax:
Practice Address - Street 1:5884 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-6205
Practice Address - Country:US
Practice Address - Phone:513-239-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSV9254261041S0200X, 122300000X, 106H00000X, 111NN1001X, 111NS0005X, 163W00000X, 163WF0300X, 163WH0200X, 163WS0200X, 363LF0000X, 364SF0001X, 364SL0600X, 103TH0100X, 101YS0200X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No122300000XDental ProvidersDentist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No163W00000XNursing Service ProvidersRegistered Nurse
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool