Provider Demographics
NPI:1427372721
Name:WESTON, KHALILAH (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALILAH
Middle Name:
Last Name:WESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KHALILAH
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:505 GILMAN CT N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716
Mailing Address - Country:US
Mailing Address - Phone:734-657-5407
Mailing Address - Fax:
Practice Address - Street 1:995 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705
Practice Address - Country:US
Practice Address - Phone:727-230-3423
Practice Address - Fax:217-636-3056
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1184002084N0400X, 2084P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine