Healthcare Provider Details

I. General information

NPI: 1255643250
Provider Name (Legal Business Name): CASHENA LATEEFAH HASTIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL PARK, STE 141 GENERAL PSYCHIATRY
COLUMBIA SC
29203
US

IV. Provider business mailing address

3555 HARDEN STREET EXT 15 MEDICAL PARK, SUITE 300
COLUMBIA SC
29203-6894
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1433
  • Fax: 803-434-4351
Mailing address:
  • Phone: 803-434-6412
  • Fax: 803-434-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL32715
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: