Provider Demographics
NPI:1457896557
Name:HANNA MAHASE, CHERILYN PATRICE (MBBS MD FACP)
Entity Type:Individual
Prefix:DR
First Name:CHERILYN
Middle Name:PATRICE
Last Name:HANNA MAHASE
Suffix:
Gender:F
Credentials:MBBS MD FACP
Other - Prefix:DR
Other - First Name:CHERILYN
Other - Middle Name:PATRICE
Other - Last Name:HANNA MAHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6841 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4418
Mailing Address - Country:US
Mailing Address - Phone:904-862-2175
Mailing Address - Fax:904-862-2330
Practice Address - Street 1:6841 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4418
Practice Address - Country:US
Practice Address - Phone:904-862-2175
Practice Address - Fax:904-862-2330
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL128822207R00000X, 208000000X
FLME128822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics