Healthcare Provider Details

I. General information

NPI: 1558293340
Provider Name (Legal Business Name): MARIAM HANNA YOUSSEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35648 US HWY 27 N
HAINES CITY FL
33844-3731
US

IV. Provider business mailing address

1695 W GROVELEAF AVE
PALM HARBOR FL
34683-3927
US

V. Phone/Fax

Practice location:
  • Phone: 863-900-4593
  • Fax:
Mailing address:
  • Phone: 727-348-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: