Healthcare Provider Details

I. General information

NPI: 1538516091
Provider Name (Legal Business Name): NELLAB HASHIMI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21332 SW LANGER FARMS PKWY STE 126
SHERWOOD OR
97140-9138
US

IV. Provider business mailing address

21332 SW LANGER FARMS PKWY STE 126
SHERWOOD OR
97140-9138
US

V. Phone/Fax

Practice location:
  • Phone: 631-474-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11384
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number059131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: