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General NPI Number Information
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NPI Number | 1508307554
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Entity Type | Individual
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Provider Name | SHAFA HASSAN
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Gender | Female
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 4132 LINDEN AVE SUIT 307
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City | DAYTON
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State | OH
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Zip | 45432-3935
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Country | US
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Telephone | 937-830-0303
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Fax | 937-938-1220
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Provider Business Mailing Address
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Address Line | 4550 FOXTON CT
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City | DAYTON
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State | OH
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Zip | 45414-3935
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Country | US
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Telephone | 937-949-3272
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Fax | 937-938-1220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3845644
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License Number State | OH
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