Provider Demographics
NPI:1952085193
Name:HAJRA, AMATUL HABEEB (MD)
Entity Type:Individual
Prefix:
First Name:AMATUL
Middle Name:HABEEB
Last Name:HAJRA
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 1:3557 CHESHIRE SQ APT B
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3960
Mailing Address - Country:US
Mailing Address - Phone:352-300-7636
Mailing Address - Fax:
Practice Address - Street 1:3557 CHESHIRE SQ APT B
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3960
Practice Address - Country:US
Practice Address - Phone:352-300-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE37978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine