Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME122715 | FL |
N | 111NI0900X | Internist | ME122715 | FL |
Y | 207RN0300X | Nephrologist | ME122715 | FL |
NPI | 1043516511 |
---|---|
Provider Name | Dr. Adey A A Hasan |
First Address | St Augustine, FL 32085-1779 |
Second Address | St Augustine, FL 32086-5135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2011 |
Last Update Date | 05/08/2020 |