Healthcare Provider Details

I. General information

NPI: 1255560223
Provider Name (Legal Business Name): SHADY ELSAYED HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 FULTON ST 2ND FLOOR
BROOKLYN NY
11201-5103
US

IV. Provider business mailing address

63 OTTAVIO PROMENADE
STATEN ISLAND NY
10307-2410
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-1000
  • Fax: 718-260-0072
Mailing address:
  • Phone: 917-882-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number33376
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number276803
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA09992600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: