Provider Demographics
NPI:1811340292
Name:HANAFY, JAILAN (MD)
Entity type:Individual
Prefix:
First Name:JAILAN
Middle Name:
Last Name:HANAFY
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 1:15 MEDICAL PARK STE 141
Mailing Address - Street 2:GENERAL PSYCHIATRY DEPARTMENT
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-1433
Mailing Address - Fax:803-434-4062
Practice Address - Street 1:1214 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1897
Practice Address - Country:US
Practice Address - Phone:847-577-7705
Practice Address - Fax:803-434-4062
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL398472084P0800X
IL0361489812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry