Provider Demographics
NPI:1902296700
Name:KHAN, SHEHZAD ULLAH (RN)
Entity Type:Individual
Prefix:
First Name:SHEHZAD
Middle Name:ULLAH
Last Name:KHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1615
Mailing Address - Country:US
Mailing Address - Phone:631-524-4152
Mailing Address - Fax:
Practice Address - Street 1:79 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1615
Practice Address - Country:US
Practice Address - Phone:631-524-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse