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NPI Code Detail

MEDICARE: SHADEED HASAN II

MEDICARE: SHADEED HASAN II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor36287CA
21041C0700XClinical Social WorkerLCSW84937CA
3390200000XStudent in an Organized Health Care Education/Training Program
4103K00000XBehavior Analyst1-16-22697CA

General Provider Information

NPI Number : 1003130626
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHADEED HASAN II
Provider Business Mailing Address
First Line : 500 FAIRWAY DR STE 102
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1817
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Provider Business Practice Location Address
First Line : 1811 GRAND CANAL BLVD STE 2
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8107
Country : US
Telephone Number : 877-418-2978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2010
Last Update Date : 12/28/2021

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Directions to “ SHADEED HASAN II ” Practice Location

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