Provider Demographics
NPI:1699446773
Name:HASSANEIN, SHAIMAA MAHMOUD
Entity type:Individual
Prefix:DR
First Name:SHAIMAA
Middle Name:MAHMOUD
Last Name:HASSANEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 NW 10TH PL
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6709
Mailing Address - Country:US
Mailing Address - Phone:415-802-8241
Mailing Address - Fax:
Practice Address - Street 1:6820 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4570
Practice Address - Country:US
Practice Address - Phone:954-743-1918
Practice Address - Fax:954-743-1915
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH255793836210Medicaid