Provider Demographics
NPI:1861738619
Name:KHAN, TAHIRA JAVEEN (BA)
Entity type:Individual
Prefix:MISS
First Name:TAHIRA
Middle Name:JAVEEN
Last Name:KHAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 218TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-2149
Mailing Address - Country:US
Mailing Address - Phone:646-462-1378
Mailing Address - Fax:
Practice Address - Street 1:1 ODELL PLZ
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1402
Practice Address - Country:US
Practice Address - Phone:914-965-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency