Individual provider Active NPI

Shirin Hasan, MD

  • Child & Adolescent Psychiatry Physician
  • Orlando, FL
National Provider Identifier
1164571840
Registry record updated Oct 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
ME64918 Issued in FL
Practice address
1717 S Orange Ave Ste 100
Orlando, FL 32806-2946
Phone
(407) 650-7715
Fax
(407) 650-7124
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X ME64918 FL Primary

Addresses

Primary practice location

1717 S Orange Ave Ste 100
Orlando, FL 32806-2946

Mailing address

PO Box 191
Provider Enrollment
Rockland, DE 19732-0191
Phone (302) 651-6212

Other identifiers 2

IdentifierTypeStateIssuer
257280000MedicaidFL
25882OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170525000364 FL Practitioner - Psychiatry 6608143516 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Mar 13, 2017 Accepting new patients
The Nemours Foundation Current Accepting new patients
The Nemours Foundation CurrentSince Mar 13, 2017 Accepting new patients

Locations

807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600

1717 S Orange Ave
Ste 100
Orlando, FL 32806

6535 Nemours Pkwy
Orlando, FL 32827
Phone (407) 567-4000

Interoperability endpoints

  • Direct secure messaging: shasan7667@direct.nemours.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1164571840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-6212",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062946",
            "telephone_number": "407-650-7715",
            "fax_number": "407-650-7124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASAN",
        "first_name": "SHIRIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME64918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257280000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "25882",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.