Healthcare Provider Details

I. General information

NPI: 1326485723
Provider Name (Legal Business Name): SHANNON HAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 CLAY ST
WINTER PARK FL
32789-5499
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-5371
  • Fax: 407-644-1417
Mailing address:
  • Phone: 813-286-0333
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME132199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: