Provider Demographics
NPI:1578286803
Name:KHALID, ASMA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASMA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASMA
Other - Middle Name:
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1174 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1943
Mailing Address - Country:US
Mailing Address - Phone:631-464-8912
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8408
Practice Address - Country:US
Practice Address - Phone:631-464-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029002363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty