Provider Demographics
NPI:1043451941
Name:ABDELLA, HANEEN YASIN (MD)
Entity type:Individual
Prefix:
First Name:HANEEN
Middle Name:YASIN
Last Name:ABDELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANEEN
Other - Middle Name:SALIH
Other - Last Name:YASIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5603
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-2234
Practice Address - Fax:954-985-2288
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1044412080P0207X, 208000000X
GA64171390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009045200Medicaid