Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 220153 | NY |
NPI | 1003981507 |
---|---|
Provider Name | Shahana Khan |
First Address | N Bellmore, NY 11710 |
Second Address | N Bellmore, NY 11710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |