Provider Demographics
NPI:1043657224
Name:KHAN, FAIZA MUMTAZ (SLP)
Entity Type:Individual
Prefix:MRS
First Name:FAIZA
Middle Name:MUMTAZ
Last Name:KHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 NW 46TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4024
Mailing Address - Country:US
Mailing Address - Phone:305-342-0371
Mailing Address - Fax:
Practice Address - Street 1:14201 W SUNRISE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-756-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist