Provider Demographics
NPI:1578250551
Name:HASSAN, SHIREEN MOHAMED
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:MOHAMED
Last Name:HASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 S ROBERTS RD # P
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1934
Mailing Address - Country:US
Mailing Address - Phone:708-974-2923
Mailing Address - Fax:
Practice Address - Street 1:10500 S ROBERTS RD # P
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1934
Practice Address - Country:US
Practice Address - Phone:708-974-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0347241223G0001X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program