=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326128323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAMLET HASSAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 05/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3611 SW 107TH AVE SUITE 10
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-594-4421
-----------------------------------------------------
Fax | 305-594-4644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7154 N UNIVERSITY DR SUITE 323
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-213-3702
-----------------------------------------------------
Fax | 954-473-0211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME-88939
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------