Provider Demographics
NPI:1679751275
Name:KHAN, SHAKIRA (BSC)
Entity Type:Individual
Prefix:MS
First Name:SHAKIRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4202
Mailing Address - Country:US
Mailing Address - Phone:631-368-4433
Mailing Address - Fax:631-368-6338
Practice Address - Street 1:520 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4202
Practice Address - Country:US
Practice Address - Phone:631-368-4433
Practice Address - Fax:631-368-6338
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01568423Medicaid