Provider Demographics
NPI:1194769141
Name:HASAN, SYED NADEEM (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:NADEEM
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 STATE ROAD 54 STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-6061
Mailing Address - Country:US
Mailing Address - Phone:727-845-1933
Mailing Address - Fax:727-845-7307
Practice Address - Street 1:5824 STATE ROAD 54 STE 101
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-6061
Practice Address - Country:US
Practice Address - Phone:727-845-1933
Practice Address - Fax:727-845-7307
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252995500Medicaid
FL56193Medicare ID - Type Unspecified