Basic Information
| Provider Information | |||||||||
| NPI: | 1073592036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNA | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 STATION PLAZA NORTH | ||||||||
| Address2: | STE 310 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166633822 | ||||||||
| FaxNumber: | 5166634740 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 STATION PLAZA NORTH | ||||||||
| Address2: | STE 310 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166633822 | ||||||||
| FaxNumber: | 5166634740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | NYS201111 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1477073 | 01 | UNITED HEALTHCARE | OTHER | 5036625 | 01 | AETNA | OTHER | 110159808 | 01 | RAILROAD MEDICARE | OTHER | 1307781 | 01 | FIRSTHEALTH | OTHER | 22N681 | 01 | BC/BS | OTHER | 4539578005 | 01 | CIGNA | OTHER | P623635 | 01 | OXFORD | OTHER | 01837558 | 05 | NY | MEDICAID | LC2442 | 01 | HEALTHNET | OTHER | 74238 | 01 | VYTRA | OTHER | 2599727 | 01 | GHI | OTHER |