Provider Demographics
NPI:1912861162
Name:KHAN, SHANA
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25228 COPA DEL ORO DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2587
Mailing Address - Country:US
Mailing Address - Phone:510-363-6278
Mailing Address - Fax:
Practice Address - Street 1:25228 COPA DEL ORO DR UNIT 103
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2587
Practice Address - Country:US
Practice Address - Phone:510-363-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-12
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA738179164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse